Comparison of pediatric and adult antibiotic-associated diarrhea andClostridium difficileinfections

Abstract

Antibiotic-associated diarrhea (AAD) and Clostridium difficile infections (CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases PubMed (June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications (required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar (discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.

Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis

“…Physician specialty was also an important factor; compared with Peds, FP and GIM were more likely to test patients with fever, patients who were sick enough to consider inpatient admission or had a recent hospitalization, and those with history of recent antibiotic use. These factors can be associated with sicker patients, including those with C. difficile infections [16], bringing C. difficile to the forefront of a differential diagnosis in an adult patient with AGE with relevant symptoms and risk factors. Peds may be less likely to include bacterial pathogens high on the differential for outpatients as viruses cause most AGE and outpatient AGE visits in children [3].…”

Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

“…Compared to adult AAD, pediatric AAD has a quicker onset after antibiotic exposure but a shorter duration, and is associated with fewer complications (surgery, Intensive Care Unit stay, fever etc.) (McFarland, Ozen, Dinleyici, & Goh, 2016). Current treatment recommendations for AAD from the American College of Gastroenterology are to discontinue antibiotics and, if Clostridium difficile infection is found in a patient ≥ 10 years old, to begin with metronidazole treatment and adjust care as necessary (Surawicz et al, 2013).…”

Antibiotic susceptibility and resistance profiles of Romanian Clostridioides difficile isolates

“…The main risk factors for colonization with toxigenic C. difficile and associated disease are considered to be hospitalisation in acute or long-term care units, advanced age (≥ 65 years) [1,6] and prolonged treatment with wide-spectrum antibiotics like clindamycin, cephalosporins or fluoroquinolones, to which many C. difficile strains are non-susceptible [2,[6][7][8][9][10]. C. difficile infection (CDI) may also be community-associated, targeting both paediatric (> 2 years) and adult patients [2,11], through contact with spore-contaminated surfaces, infected persons, or as zoonotic infections [3]. Many clinical isolates in Europe, including those belonging to PCR ribotypes (PR) 001, 012, 017, 018, 027 or 078, are considered multi-drug resistant (MDR) [12,13].…”