Difficile Infections In Children Research Articles

Detection of toxigenic Clostridium difficile in paediatric patients

IntroductionOur main objective was a revision of clinical, microbiological and epidemiological results of Clostridium difficile-associated infection in paediatric patients (2010–2015). We compared the diagnoses performed by detection of toxins in faeces and those performed by real-time PCR. MethodsThis retrospective study included 82 paediatric patients. Detection of toxigenic C. difficile was performed sequentially, in diarrheal faeces and under clinical request. ResultsA total of 39% of the patients were attended at Haematology–Oncology Unit and >50% of them had previously received cephalosporins. Fever associated with diarrhoea was more frequent in the group of toxin detection, whereas not receiving specific antibiotic treatment was more frequent in the group of positive PCR, without statistically significant differences. ConclusionsWe highlight the presence of C. difficile infection in children under 2 years old. A diagnostic testing in selected paediatric patients would be advisable when there is clinical suspicion of infection.

C. difficile Infection in Children: What’s New?

The purpose of this review is to present the epidemiology of Clostridium difficile infection in children and to present a number of clinical challenges in diagnosis and therapy that are unique to the pediatric population. Current research has focused on novel methods of prevention and treatment of C. difficile infection in children. Fecal microbial transplantation (FMT) for recurrent C. difficile is increasingly prescribed for children, and recent data includes comparisons of effectiveness and tolerability between methods of delivery. The incidence of C. difficile infection in children has risen in recent decades both in healthy children and those with underlying comorbidities. Antibiotic use, acid suppressive medication use, and the presence of enteric feeding tubes are well-documented risk factors. There is no standard method of testing for C. difficile infection in children, which complicates epidemiological tracking and detection of active disease versus asymptomatic colonization. First-line therapy for initial infection in children is metronidazole, while vancomycin may be reserved for those with severe infection or high risk of complications. Recurrence of infection is frequent, and while repeat courses of antibiotics may be effective, fecal microbial transplant should be considered a safe and efficacious alternative therapy.

Community-acquired Clostridium difficile infection in Serbian pediatric population.

Carriage of Clostridium (C.) difficile in the intestinum of children, as well as its role in the disease (diarrhea) onset, is still controversial. The aim of this study is to investigate the community-acquired Clostridium difficile infection (CA-CDI) in Serbian pediatric population and to describe the basic clinical characteristics and risk factors for CA-CDI occurrence in Serbian pediatric population. The data obtained from 63 Serbian pediatric patients with CA-CDI and from control group of 126 children with community-acquired diarrhea, whose stool specimens were negative for C. difficile and toxins A/B, were mutually compared. In the current work, we found that children with CA-CDI display a significantly less severe disease clinical presentation than children with diarrheas of other origin. Lethal outcome was noted in two cases, but in children with severe underlying diseases (Crohn's disease and leukemia). By using the multivariate statistical regression model, the following statistically significant risk factors for community-acquired C. difficile-associated diarrhea development were determined: previous application of laxatives (OR = 0.199, CI 0.55-0.79, p = 0.015), general antibiotic use during the previous 2months (OR = 0.05, CI 0.02-0.17, p < 0.001), and specifically the use of penicillins (OR = 0.112, CI 0.04-0.31, p < 0.0001) and cephalosporins (OR = 0.16, CI 40.06-0.44, p < 0.0001). Antibiotics from the groups of cephalosporins and penicillins were found to be the most important independent risk factors. Laxative application plays a significant role in the community-acquired Clostridium difficile infections in children, with mechanisms that are not completely understood.

Association of Acid Suppression and Antimicrobial Use with Clostridium difficile Infection in Children

Background Clostridium difficileinfections (CDIs) can cause severe diarrhea and be potentially life-threatening, especially in children. Possible risk factors include age, being immunocompromised, prior antibiotic exposure, the use of antacids, and diseases that alter intestinal microbiota. Data in adults are vast while limited data is available in children. The objectives of this study are to identify pediatric risk factors and determine if an association between acid suppression and CDI’s in children exists.MethodsA retrospective study was conducted between November 1, 2013 and October 31, 2016 at Arkansas Children’s Hospital. Children ages 1 – 18 years with a positive C. diff PCR test and ≥3 loose stools documented were included. Cases were excluded if previous positive PCR was within 60 days. Data collection included age, sex, encounter type (inpatient or outpatient), acid suppressing agents, previous antimicrobials within last 90 days and comorbidities including transplant, chronic pulmonary, hematology/oncology, and GI tract diseases. Statistical methods included descriptive analyses, χ2test, and Kruskal–Wallis test.ResultsA total of 139 cases of CDI among 123 patients were evaluated. Of these cases, the median (IQR) age is 8 years (3–13) with 77 (55.4%) being male and 86 (61.9%) of CDI cases identified inpatient of which 75 came from outpatient. Pediatric risk factors identified in C. diff cases included exposure to acid suppressing agents [61 (43.9%)] and antimicrobials [98 (70.5%)] with 90 (64.7%) having ≥1 comorbidities. Cases having ≥1 comorbidities were found to be associated with previous antacid exposure (P < 0.0005) while antimicrobial(s) use was associated with CDI hospitalization (P = 0.001). Similarly, exposure to either antacid suppression or antimicrobials or both with comorbidities were found to have a significant association (P < 0.0005) and associated with CDI hospitalization (P = 0.001).ConclusionExposure to acid suppression in patients with comorbidities was associated with increased risk of CDI. Antimicrobial usage was associated with increased risk for hospitalization due to CDI. As pediatric outpatient antimicrobial stewardship evolves, improving CDI rates can center on improving antimicrobial and acid suppressive agents usage.Disclosures All authors: No reported disclosures.

Risk Factors for Community-Associated Clostridium difficile

Research Article| October 01 2017 Risk Factors for Community-Associated Clostridium difficile AAP Grand Rounds (2017) 38 (4): 43. https://doi.org/10.1542/gr.38-4-43 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Risk Factors for Community-Associated Clostridium difficile. AAP Grand Rounds October 2017; 38 (4): 43. https://doi.org/10.1542/gr.38-4-43 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: clostridium difficile, community, outpatients, exposure, cephalosporins, clindamycin, fluoroquinolones Source: Adams DJ, Eberly MD, Rajnik M, et al. Risk factors for community-associated Clostridium difficile infection in children. J Pediatr. 2017; 186: 105– 109; doi: https://doi.org/10.1016/j.jpeds.2017.03.032Google Scholar Investigators from the Naval Medical Center in Virginia and Uniformed Services University in Maryland conducted a cross-sectional analysis to identify risk factors associated with community-associated Clostridium difficile infection (CDI). Investigators identified cases by using billing records from the TRICARE Management Activity Military Health System database, which includes all eligible military dependents cared for in both military and civilian facilities. Cases were defined as children aged 1–18 years old who received care from 2001 to 2013 and had an ICD-9 diagnostic code for CDI. Any child hospitalized prior to the diagnosis of CDI was excluded. Cases were matched by age and sex to 3 control subjects who did not have an ICD-9 diagnostic code for CDI. The primary exposure was medications prescribed in the 12 weeks preceding the date of the first CDI, as determined by using outpatient pharmacy records. Medications were grouped into oral antibiotics (clindamycin; fluoroquinolones; sulfonamides; macro-lides; penicillins; amoxicillin and clavulanate; tetracyclines; and first-, second-, and third-generation cephalosporins), gastric-acid suppression medications (proton pump inhibitors, H2-receptor antagonists), and corticosteroids. Secondary exposures included visits to outpatient health care settings, siblings <1 year of age, and family members with a CDI diagnosis. The investigators used logistic regression to determine the odds of CDI according to each exposure after adjusting for potential confounders. There were 1,331 cases and 3,993 control subjects included in the analysis. Among the cases, 59.7% had exposure to ≥1 antibiotic. When compared to control subjects, the antibiotic exposures most associated with CDI were fluoroquinolones (4% in cases vs 0% in control subjects), clindamycin (8% in cases vs <1% in control subjects; adjusted odds ratio [aOR], 73; 95% confidence interval [CI], 13.8–384.7), and third-generation cephalosporins (16% in cases vs 1% in control subjects; aOR, 16.3; 95% CI, 9.1–29.3). The odds of CDI also increased with the number of antibiotic class exposures, from an aOR of 6.1 with exposure to 1 class of antibiotic, an aOR of 22.1 with exposure to 2 classes of antibiotics, and an aOR of 38.5 with exposure to ≥3 antibiotic classes. Other medications significantly associated with CDI included proton-pump inhibitors (aOR, 8.2) and H2-receptor antagonists (aOR, 3.3). Outpatient health care clinic visits were also significantly associated with CDI (aOR, 1.35), as were family members with a CDI diagnosis. The investigators conclude that CDI is associated with a number of commonly prescribed medications in the outpatient setting. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. CDI, the most common cause of health care–associated diarrhea in the United States, is increasingly recognized in community settings (AAP Grand Rounds, March 2014;31[3]:30).1 In the current study, each additional outpatient clinic visit increased the odds of children developing... You do not currently have access to this content.

Detección de Clostridium difficile toxigénico en pediatría

IntroductionOur main objective was a revision of clinical, microbiological and epidemiological results of Clostridium difficile-associated infection in paediatric patients (2010-2015). We compared the diagnoses performed by detection of toxins in feces and those performed by real-time PCR. MethodsThis retrospective study included 82 paediatric patients. Detection of toxigenic C. difficile was performed sequentially, in diarrheal feces and under clinical request. ResultsA total of 39% of the patients were attended at Haematology-oncology Unit and >50% of them had previously received cephalosporins. Fever associated with diarrhea was more frequent in the group of toxin detection, whereas not receiving specific antibiotic treatment was more frequent in the group of positive PCR, without statistically significant differences. ConclusionsWe highlight the presence of C. difficile infection in children under 2years old. A diagnostic testing in selected paediatric patients would be advisable when there is clinical suspicion of infection.

Clostridium diffi cile infection in children: characteristics and treatment – a single-center study from Romania

The incidence of Clostridium diffi cile infection (CDI) in children is progressively increasing. The study evaluated the characteristicsand antibacterial treatment of CDI at a Romanian pediatric gastroenterology department. We performed a retrospective study toanalyze cases diagnosed with CDI, identifi ed through immunoassays for Clostridium diffi cile toxins in stools, between January 1,2005 and December 31, 2015. Eighty-nine episodes of CDI were diagnosed in 73 patients. We noticed an increasing incidence reachingmaximum in 2014 with 6.9 cases/1000 patients. Almost 40% of patients had community-acquired CDI. The most frequentlyassociated comorbidities were infl ammatory bowel disease and cow’s milk allergy. There was a small percentage of recurrent episodes(24.2%). Metronidazole was administered as fi rst-line treatment in 49.2% of mild/moderate cases and proved eff ective in 79.4%of these. More than 70% of all patients in which metronidazole was not effi cient had comorbidities, compared to 22.2% of patientswhere metronidazole was effi cacious. The alternative was vancomycin which cured the disease in all cases. In severe forms, a combinationof intravenous metronidazole and oral vancomycin was the effi cient solution. Oral vancomycin was the effi cacious treatmentfor the fi rst recurrence. We report an increasing incidence of CDI in Romanian children. The failure rate for metronidazoletreatment was low, thus metronidazole may be safely recommended for the fi rst episode of mild/moderate CDI. Vancomycin provedeff ective in all cases, regardless of the fi rst episode or recurrence, and may be used effi ciently as fi rst-line treatment.Key words: Clostridium diffi cile; antibacterial treatment; children

Clostridium diffi cile infection in children: characteristics and treatment – a single-center study from Romania

Clostridium diffi cile infection in children: characteristics and treatment – a single-center study from Romania

Fecal microbiota transplantation for recurrent Clostridium difficile infection in children

Fecal microbiota transplantation (FMT) is a relatively simple, promising treatment for recurrent Clostridium difficile infection. While there are a wide variety of approaches including mode of delivery, the results are nonetheless encouraging, even amongst younger children. Experience with FMT in the pediatric population is increasing, showing similar success compared to adults. This article will provide an overview of C. difficile infection along with review of the rationale, methods and complications of FMT including the current experience of FMT in children.

Risk Factors for Community-Associated Clostridium difficile Infection in Children

To characterize the medication and other exposures associated with pediatric community-associated Clostridium difficile infections (CA-CDIs). We performed a case-control study using billing records from the US military health system database. CA-CDI cases included children 1-18 years of age with an outpatient International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for Clostridium difficile infection (CDI) from 2001 to 2013. Each case was matched to 3 controls without CDI by age and sex. Children hospitalized at any time before their CDI were excluded. Outpatient pharmacy records were used to identify medication exposures in the preceding 12 weeks. In addition, we evaluated recent outpatient healthcare exposure, exposure to a sibling younger than 1 year of age, or to a family member with CDI. A total of 1331 children with CA-CDI were identified and 3993 controls were matched successfully. Recent exposure to fluoroquinolones, clindamycin (OR 73.00; 95% CI 13.85-384.68), third-generation cephalosporins (OR 16.32; 95% CI 9.11-29.26), proton pump inhibitors (OR 8.17; 95% CI 2.35-28.38), and to multiple classes of antibiotics, each was associated strongly the subsequent diagnosis of CA-CDI. Recent exposure to outpatient healthcare clinics (OR 1.35; 95% CI 1.31-1.39) or to a family member with CDI also was associated with CA-CDI. CA-CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.

Recurrent Clostridium difficile Infection in Children: Patient Risk Factors and Markers of Intestinal Inflammation.

The management of Clostridium difficile infection (CDI) in children is complicated by recurrence rates of 20%-30%. The identification of risk factors associated with recurrent disease might allow early recognition of those children at highest risk. Pediatric patients with CDI were identified through clinical laboratory records at 2 tertiary-care children's hospitals from March 2013 through May 2014. Subjects were enrolled and followed for 60 days to assess for recurrent CDI (rCDI). Blood samples were obtained at enrollment to evaluate host interleukin (IL)-8 polymorphisms and anti-toxin A antibody levels; stool samples were obtained for inflammatory markers (lactoferrin, calprotectin, IL-8) and C. difficile ribotype 027 strain status. Thirty days post enrollment, another serum sample was obtained to compare antibody responses. Of the 28 pediatric patients enrolled, 27 completed follow-up and 8 (30%) experienced rCDI. At enrollment, children with malignancy had significantly lower stool calprotectin, lactoferrin and IL-8 than those without malignancy. There was a trend toward increased stool inflammatory markers in those who later developed rCDI. The IL-8 A/A genotype was not associated with recurrent disease. No patients were found to have ribotype 027 or an antibody increase to toxin A. The rate of rCDI in our pediatric cohort was 30%. Children with rCDI had a trend toward higher fecal inflammatory markers with the initial infection, and these values were lower in children with malignancy. Fecal lactoferrin, calprotectin and IL-8 should be further studied to determine their value in predicting the risk of rCDI in children.

Risk Factors for Community-Associated Clostridium difficile Infection in Children

BackgroundIncidence of Clostridium difficile infection (CDI) in children has been shown to be highest among those aged 1 to 3 years, with similar clinical presentation, disease severity, and outcomes as older children. In addition, a large proportion of CDI in children are community-associated (CA), but few data exist regarding associated risk factors. We sought to identify CA-CDI risk factors in younger children.MethodsWe enrolled children from 8 geographically-diverse U.S. sites during October 2014–February 2016. Case-patients were defined as children aged 12–60 months with a positive C. difficile stool specimen collected as an outpatient or within 3 days of hospitalization, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one randomly selected control (child with no prior history of CDI) by site and age group. Caretakers were interviewed about participants’ relevant exposures in the 12 weeks prior to case-patient’s illness onset date; univariate analysis was performed using exact conditional logistic regression.ResultsOf 138 children, 43.5% were female; 69.6% were 12–23 months old. A significantly higher proportion of cases than controls had: an underlying chronic medical condition (33.3% vs 11.9%; P = 0.02); a neonatal intensive care unit (NICU) stay at time of birth (26.9% vs 13.2%; P = 0.04); or recent antibiotic exposure (53.6% vs 20.6%; P = 0.0001). More cases than controls had recent higher-risk outpatient healthcare exposures (emergency department, outpatient procedure and surgical centers, hospital-based outpatient settings, or urgent care) (34.9% vs 19.1%; P = 0.06) or a household member with diarrhea (36.2% vs 20.6%; P = 0.05). No difference was found in the proportion of cases and controls who had a feeding tube (2.9% vs 0%; P = 0.50) or a recent exposure to gastric acid suppressants (6.1% vs 2.9%; P = 0.63).ConclusionYoung children with underlying disease, NICU stay, or recent antibiotic use might be at higher risk for CA-CDI. Improving outpatient antibiotic use, particularly among children with comorbidities, might reduce CA-CDI in this population. Further investigation of other risk factors, including outpatient healthcare and household exposures, is needed.Disclosures All authors: No reported disclosures.

Clostridium difficile infections in young infants: Case presentations and literature review

It has been assumed that symptomatic Clostridium difficile infections do not occur in young infants, as this specific group would lack specific C. difficile toxin receptors. As a consequence, it is often current practice not to test for C. difficile in neonates and young infants up to 2 years of age presenting with (bloody) diarrhea. The evidence to support this is, however, weak and largely based on small, poorly designed animal studies. We present two young infants with recurrent bloody diarrhea following antimicrobial therapy, positive testing for toxigenic C. difficile and successfully treated with metronidazole and vancomycin, and provide an overview of the literature on C. difficile infections in children under two years of age. Both our case histories and the literature search provide evidence for C. difficile infection as a potential cause of bloody diarrhea in neonates and young infants, in particular after previous treatment with antimicrobials.

Clostridium Difficile Infection in Children: A Review.

Clostridium difficile is a sporogenic, anaerobic, Gram-positive, emerging enteric pathogen. It represents the most common cause of health care-associated diarrhoea in the United States, with significantly associated morbidity, mortality, and health care costs. Historically regarded as a little more than an innocent coloniser bystander of the gastrointestinal tract of children, C difficile has increasingly demonstrated its behaviour as a true pathogen in the paediatric age groups. This organism may be responsible for a broad spectrum of diseases in children, ranging from self-limiting secretory diarrhoea to life-threatening conditions, such as pseudomembranous colitis, toxic megacolon, intestinal perforation, and septic shock. The incidence and severity of C difficile infection are, however, not completely understood in this population. In particular, although asymptomatic carriage remains high among infants, the clinical significance of detecting C difficile in children aged 1 to 3 years is not fully understood. Moreover, recent epidemiological surveillance has demonstrated a rise in the incidence of C difficile infection, particularly in the community and in low-risk settings. Interestingly, such cases may not show the disease pattern to be associated with typical risk factors, such as recent exposure to antimicrobial drugs or on-going contacts with the health care system.The purpose of the present review is to present the features of C difficile infection that are unique to paediatric patients and to update paediatricians on information and recommendations regarding C difficile infection in children.

Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8%) had CA-CDI. Children with HA-CDI (39.2%) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7% of cases (87/123) and vancomycin in 29.3% (36/123), with similar success rates. Recurrence occurred in 16 children (10.8%), and 3 (2%) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.

Diagnosis of Clostridium difficile Infections in Children.

The detection and diagnosis of Clostridium difficile infection in pediatric populations have some unique considerations in comparison to testing in adults. The testing methodologies, including toxigenic culture, cell cytotoxicity, antigen detection, and, more recently, molecular testing, are the same in all age groups. However, limited data exist on the specific performance characteristics in children. In this review, we focus on the challenges of testing in pediatric populations and assess the available data on test performance in these populations. Additionally, a review of the existing guidance for testing is provided.

Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease.

Children with inflammatory bowel disease (IBD) are disproportionately susceptible to Clostridium difficile infection (CDI) and the incidence is increasing. There has also been growing recognition of asymptomatic C. difficile colonization in pediatric IBD, which can sometimes be very difficult to distinguish from symptomatic C. difficile-associated disease in this population. In this study, we discuss the current knowledge of C. difficile infection in children with IBD, reviewing epidemiology, risk factors, and outcomes that often differ from the adult IBD population, and discuss the complexities and dilemmas of diagnosing and treating CDI in pediatric IBD.

Fecal Microbiota Transplantation in Refractory Clostridium difficile Infection in Children: Case Report and Review of the Literature

The human gastrointestinal tract evolves gradually from being sterile as neonates to being populated with trillions of bacterial species existing symbiotically for proper colonic function [1]. Disruption of homeostasis predisposes the gastrointestinal tract to increased incidence of enteric infections. Antibiotic use and immunocompromised states have been associated with an increased incidence of Clostridium difficile infection (CDI). Although approximately 35% of children's guts are colonized with CDI, it rarely causes symptoms [5]. Antibiotic therapy is considered first line for CDI; however, fecal microbiota transplantation (FMT) has recently gained favorable results for refractory and recurrent cases [6]. This involves reintroducing typical microbiota to reestablish balance of the gut flora [6,7]. We report a case of refractory CDI affecting half of an immunocompromised child's life that was cured with single FMT treatment. A 4-year-old male born via cesarean section at 37 weeks was diagnosed with a genetic disorder, Kabuki syndrome. His early life was complicated by recurrent infections, requiring several courses of antibiotics. As a result, he developed refractory CDI that lasted for 30 months, affecting his growth. His parents sought alternative options in which he was evaluated for FMT. He underwent FMT with his father as the stool donor. A 250mL aliquot of stool slurry was infused into the terminal ileum via colonoscopy, according to our institution's protocol. The child recovered from CDI with decreased bowel movements within 24 hours. He remained CDI negative and asymptomatic at 8 weeks after the procedure. Antibiotic use and immunocompromised states have been associated with an increased incidence of CDI [6]. CDI causes profuse diarrhea and may progress to colitis or complications including multi-organ failure and sepsis [6]. Recurrence after initial treatment course with antibiotics is noted to be as high as 20% [8]. In this case, Kabuki syndrome predisposed this patient to multiple infections requiring several courses of antibiotics. Each course of antibiotics caused an additional insult to the homeostasis of the gut microbiome, leading to refractory CDI. FMT has been reported to successfully treat patients with recurrent CDI in immunocompetent patients; however, there have been no reported cases of FMT in the immunocompromised pediatric population with Kabuki syndrome and CDI. The success in this case should prompt consideration of FMT in he pediatric population.

Exposure to Gastric Acid-Suppression Therapy Is Associated With Health Care- and Community-Associated Clostridium difficile Infection in Children.

The aim of the study was to determine whether gastric acid-suppression therapy is associated with Clostridium difficile infection (CDI) in both inpatient and outpatient pediatric populations. We conducted a retrospective case-control study at a 200-bed academic pediatric hospital and associated outpatient clinics during 2005-2010. We defined cases as children 1 to 18 years of age with a first positive test for C difficile toxin A/B, and matched each case to 2 controls without C difficile. We conducted chart review to elicit selected comorbidities and exposure to gastric acid-suppression therapy and antibiotics in the preceding 3 months of the infection or encounter date. We used bivariate and multivariable logistic regression to evaluate the association between antacid use and CDI, controlling for potential confounders. We identified 138 children with health care- or community-associated CDIs and 276 controls. The use of any acid suppression therapy was more common in cases compared with controls (34% vs 20%, P = 0.002). When adjusted for demographic variables and comorbidities, gastric acid-suppression therapy remained significantly associated with CDI (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.0-3.1). Antibiotic use (aOR 1.7, 95% CI 1.1-2.7) and immunosuppressed state were also associated with CDI in our adjusted model (aOR 2.5, 95% CI 1.2-5.2). Gastric acid-suppression therapy was associated with both health care- and community-associated CDIs in children. Larger pediatric studies are necessary to determine the role of proton pump inhibitors specifically in causing CDI in children.

Community-acquired Clostridium difficile infection in children: A retrospective study

BackgroundCommunity acquired-Clostridium difficile infection (CDI) has increased also in children in the last years. AimsTo determine the incidence of community-acquired CDI and to understand whether Clostridium difficile could be considered a symptom-triggering pathogen in infants. MethodsA five-year retrospective analysis (January 2007–December 2011) of faecal specimens from 124 children hospitalized in the Niguarda Ca’ Granda Hospital for prolonged or muco-haemorrhagic diarrhoea was carried out. Stool samples were evaluated for common infective causes of diarrhoea and for Clostridium difficile toxins. Patients with and without CDI were compared for clinical characteristics and known risk factors for infection. ResultsTwenty-two children with CDI were identified in 5 years. An increased incidence of community-acquired CDI was observed, ranging from 0.75 per 1000 hospitalizations in 2007 to 9.8 per 1000 hospitalizations in 2011. Antimicrobial treatment was successful in all 19 children in whom it was administered; 8/22 CDI-positive children were younger than 2 years. No statistically significant differences in clinical presentation were observed between patients with and without CDI, nor in patients with and without risk factors for CDI. ConclusionsOur study shows that Clostridium difficile infection is increasing and suggests a possible pathogenic role in the first 2 years of life.