Is Clostridium difficule-associated enterocolitis in pediatric hematology/oncology a solved problem? A review of literature and the authors’ experience

Abstract

According to a number of trials in the USA, Europe, and Asia, Clostridium difficule is the most common cause of nosocomial diarrheas. It is significant that Cl. difficule-associated colitis may occasionally result in death in patients with severe comorbidities. Children with hematological, oncological and other severe diseases are no exception. This patient group may develop Cl. difficule-associated enterocolitides that lead to serious consequences. These complications bring a much greater threat to patients after hematopoietic stem cell transplantation. Long-term persistent Cl. difficule infection causes an increase in hospitalization length, drug costs, and a significant bowel lesion that may induce various complications and, as an example, graft-versus-host disease. There has been recently a decrease in the detection rates of Cl. difficule-induced enterocolitides. However, this problem has held a high position in the list of chemotherapy complications so far. This paper deals with the epidemiology, diagnosis, and therapy of different types of Cl. difficule-associated enterocolitides, as well the authors’ experience with rifaximin used to prevent this complication in children in the context of hematopoietic stem cell transplantation.