Clostridium Difficile Infection in Children

Abstract

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, diagnosis and treatment with antimicrobial drugs : A review article

“…The American Academy of Pediatrics (AAP) Committee, recommended avoiding routine testing for C. difficile in children younger than 1 year of age based on the known high rates of colonization and infrequent disease. They also recommended that testing should be limited in this age group to those with risk factors, as Hirschsprung disease or other severe motility disorders or in an outbreak situation [33]. Recent data have shown that 26% of pediatric disease that was treated due to CDI occurred in infants younger than one year of age and 5% occurred in neonates [7].…”

A severe and complicated case of recurrent Clostridium difficile colitis in a 27- month-old boy: A rare entity in young children

“…Immunotherapy with monoclonal antibodies against CD toxin has also shown positive results in adults [19]. Very rarely, colectomy is used as a treatment for the complicated and life-threatening cases of CDI [7].…”

“…The risk factors for recurrence of CDI in children include recent hospitalization, malignancy, and recent surgery, the use of the acid blocking and immunosuppressant agents and antibiotic use [7,13]. Recurrent CDI can also be treated with supportive care and pharmacotherapy such as metronidazole and vancomycin [9].…”

“…The choice of the pharmacological agent depends on the severity of the disease [9]. Conventional pharmacotherapy includes metronidazole as a first choice drug, but if symptoms persist, tapered or pulsed oral vancomycin can be added [7]. A relatively new drug option include fidaxomicin which is a macrolide antibiotic and works by inhibiting RNA synthesis through its inhibitory effect on DNA-dependent RNA polymerase [10].…”

“…The treatment of CDI includes the discontinuation of the potentially causative agent, supportive care such as hydration and if necessary, the use of pharmacological agents against CD [7,8]. The choice of the pharmacological agent depends on the severity of the disease [9].…”