Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Morris, Oliver; Tebruegge, Marc; Pallett, A.; Green, Steve M.; Pearson, Andrew D.J.; Tuck, Andrew; Clarke, Stuart C.; Roderick, Paul; Faust, Saul N

doi:10.1007/978-1-4614-4726-9_4

Cited by 4 publications

(3 citation statements)

References 92 publications

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“…In the youngest age categories, the occurrence in control subjects was comparable to that in case subjects, as were the differences in pathogen load. High numbers of C. difficile-positive detection in children without GI complaints are known [23], while asymptomatic carriership among the elderly seems much less frequent [24]. This correlates with our findings, which found decreasing relative load with age in control subjects together with increasing differences in pathogen load between case and control subjects with age (Fig.…”

Section: Discussionsupporting

confidence: 93%

Case–control comparison of bacterial and protozoan microorganisms associated with gastroenteritis: application of molecular detection

Coppenraet

Boer²,

Ruijs

et al. 2015

Clinical Microbiology and Infection

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The introduction of molecular detection of infectious organisms has led to increased numbers of positive findings, as observed for pathogens causing gastroenteritis (GE). However, because little is known about the prevalence of these pathogens in the healthy asymptomatic population, the clinical value of these additional findings is unclear. A case-control study was carried out in a population of patients served by general practitioners in the Netherlands. A total of 2710 fecal samples from case and matched control subjects were subjected to multiplex real-time PCR for the 11 most common bacterial and four protozoal causes of GE. Of 1515 case samples, 818 (54%) were positive for one or more target organisms. A total of 49% of the controls were positive. Higher positivity rates in cases compared to controls were observed for Campylobacter spp., Salmonella spp., Clostridium difficile, enteroinvasive Escherichia coli/Shigella spp., enterotoxigenic E. coli, enteroaggregative E. coli, atypical enteropathogenic E. coli (EPEC), Cryptosporidium parvum/hominis, and Giardia lamblia. However, Dientamoeba fragilis and Shiga-like toxigenic E. coli were detected significantly less frequent in cases than in controls, while no difference in prevalence was found for typical EPEC and enterohemorrhagic E. coli. The association between the presence of microorganisms and GE was the weakest in children aged 0 to 5 years. Higher relative loads in cases further support causality. This was seen for Campylobacter spp., Salmonella spp., enterotoxigenic E. coli, and C. parvum/hominis, and for certain age categories of those infected with C. difficile, enteroaggregative E. coli, and atypical EPEC. For D. fragilis and Shiga-like toxigenic E. coli/enterohemorrhagic E. coli, pathogen loads were lower in cases. Application of molecular diagnostics in GE is rapid, sensitive and specific, but results should be interpreted with care, using clinical and additional background information.

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Section: Discussionsupporting

confidence: 93%

Case–control comparison of bacterial and protozoan microorganisms associated with gastroenteritis: application of molecular detection

Coppenraet

Boer²,

Ruijs

et al. 2015

Clinical Microbiology and Infection

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“…Alongside a lack of clear CDI case definitions in those children under the age of 3 years [5], detection of C. difficile is commonly interpreted as asymptomatic colonisation and not the causative agent for diarrhoea. However, there have been reports of a potential pathogenic role of C. difficile in this patient population, as occurs in adults [4,6,7]. A recent study suggested that the use of adult markers of disease severity are not useful in guiding the management of CDI in children ≤16 years of age, which makes it difficult to design and interpret clinical studies [8].…”

Section: Introductionmentioning

confidence: 96%

Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature

Pai

Burns

Karas

et al. 2015

Eur J Clin Microbiol Infect Dis

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Although Clostridium difficile is a major cause of antibiotic-associated diarrhoea in adults, the incidence and severity of C. difficile infection (CDI) in children is unclear. One complicating factor in assessing the role of CDI in children is the possibility of co-infection with other gastrointestinal pathogens. In this review, we summarise the literature concerning C. difficile co-infections in young children, in an attempt to discuss the rate of co-infections and their potential role in the severity of CDI clinical presentation. We identified 31 studies where co-infections were analysed, comprising 1,718 patients with positive C. difficile tests. The pooled percentage of reported co-infections was 20.7% (range 0-100%). Viral co-infections were most commonly reported (46%), with bacteria and parasites accounting for 14.9% and 0.01% of cases, respectively. However, the panel of co-infections tested for varied considerably among studies and 38% of stated co-infections did not have a pathogen reported. Substantial variation in how and when tests for gastrointestinal co-infections are carried out, small sample sizes and a lack of clear CDI case definitions preclude meaningful conclusions on the true rate of co-infections in this patient population. This review suggests that co-infections may be common in children with diarrhoea who tested positive for C. difficile. Given a lack of CDI case definitions, especially in young children under the age of 5 years, a broad panel of pathogens should be tested for to exclude other microbiological causes. However, the summarised poor quality of the available literature on this subject highlights a need for further studies.

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“…C. difficile is a spore-forming, anaerobic, gram-positive bacillus bacterium which causes a wide spectrum of illnesses from asymptomatic colonization or mild diarrhea to fulminant disease characterized by toxic megacolon, sepsis, pseudomembranous colitis and death (2-4). C. difficile infection is less common in children than adults, but its prevalence is increasing in children (5-7). Disease is mainly occurred in children who have been treated with long term antibiotic therapy (8, 9).…”

Section: Introductionmentioning

confidence: 99%

Detection, Ribotyping and Antimicrobial Resistance Properties of Clostridium difficile Strains Isolated From The Cases of Diarrhea

2016

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Background:Clostridium difficile is the most prevalent cause of antibiotic-associated infectious diarrhea al-around the world. Prevalence of virulent and resistant strains of Clostridium difficile is increasing now a day. The present investigation was carried out to study the prevalence, ribotyping and antibiotic resistance pattern of C. difficile isolated from diarrheic and non-diarrheic pediatrics.Materials and methods:Four-hundred stool specimens were collected from the diarrheic and non-diarrheic pediatrics hospitalized due to the diseases other than diarrhea. Samples were cultured and their positive results were subjected to disk diffusion and PCR-based ribotyping.Results:Thirty-five out of 400 (8.75%) samples were positive for C. difficile. Prevalence of C. difficile in diarrheic and non-diarrheic pediatrics were 11.25% and 4.16%, respectively. Male had the higher prevalence of bacteria than female (P < 0.05). eight to twelve months old pediatrics were the most commonly infected group. R27 (14.28%), R1 (10.71%), R12 (7.14%), R13 (7.14%) and R18 (7.14%) were most commonly detected ribotypes. There were no positive results for studied ribotypes in non-diarrheic pediatrics. C. difficile strains had the highest levels of resistance against tetracycline (71.42%), erythromycin (57.14%), moxifloxacin (48.57%), metronidazole (28.57%) and clindamycin (22.85%) antibiotics.Conclusion:Prescription of antibiotics in diarrheic pediatrics, males and also 8-12 months old pediatrics should be done in a regular and cautious manner.

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Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

Cited by 4 publications

References 92 publications

Case–control comparison of bacterial and protozoan microorganisms associated with gastroenteritis: application of molecular detection

Case–control comparison of bacterial and protozoan microorganisms associated with gastroenteritis: application of molecular detection

Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature

Detection, Ribotyping and Antimicrobial Resistance Properties of Clostridium difficile Strains Isolated From The Cases of Diarrhea

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