Abstract
PurposeThe aim of this work was to develop a clinical practice guideline for the prevention and treatment of Clostridium difficile infection (CDI) in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation (HSCT) patients.MethodsAn international multidisciplinary panel of experts in pediatric oncology and infectious diseases with patient advocate representation was convened. We performed systematic reviews of randomized controlled trials for the prevention or treatment of CDI in any population and considered the directness of the evidence to children with cancer and pediatric HSCT patients. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to generate recommendations.ResultsThe panel made strong recommendations to administer either oral metronidazole or oral vancomycin for the initial treatment of nonsevere CDI and oral vancomycin for the initial treatment of severe CDI. Fidaxomicin may be considered in the setting of recurrent CDI. The panel suggested that probiotics not be routinely used for the prevention of CDI, and that monoclonal antibodies and probiotics not be routinely used for the treatment of CDI. A strong recommendation to not use fecal microbiota transplantation was made in this population. We identified key knowledge gaps and suggested directions for future research.ConclusionWe present a guideline for the prevention and treatment of CDI in children and adolescents with cancer and pediatric HSCT patients. Future research should include randomized controlled trials that involve children with cancer and pediatric HSCT patients to improve the management of CDI in this population.
Highlights
Clostridium difficile can be a common commensal of the normal GI flora; isolates that produce toxin can result in symptomatic infection.[1]
Fidaxomicin may be considered in the setting of recurrent Clostridium difficile infection (CDI)
The panel suggested that probiotics not be routinely used for the prevention of CDI, and that monoclonal antibodies and probiotics not be routinely used for the treatment of CDI
Summary
Clostridium difficile can be a common commensal of the normal GI flora; isolates that produce toxin can result in symptomatic infection.[1] Well-described risk factors[2,3] for C. difficile infection (CDI) include recent antibiotic and chemotherapy exposure[4,5,6] and prolonged hospitalization.[5] As these factors are common in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation (HSCT). Patients, it is not surprising that CDI has emerged as an important health care–associated infection in this population.[7]. The importance of CDI has been highlighted with the emergence of North American pulsed-field gel electrophoresis type 1, a more virulent strain associated with higher morbidity and mortality.[11] In pediatric patients with cancer, CDI has been associated with an increased risk of death.[3]
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