Clinical and microbiological characteristics of Clostridium difficile infection in children hospitalized at the Departement of Paediatric Infectious Diseases in Brno between 2013 and 2017
Authors:
V. Musil 1; L. Homola 1; M. Vrba 2; A. Braunová 1; M. Malá 1; P. Holečková 1; L. Krbková 1
Authors‘ workplace:
Klinika dětských infekčních nemocí Fakultní nemocnice, Brno a Lékařské fakulty Masarykovy univerzity, Brno
1; Oddělení klinické mikrobiologie Fakultní nemocnice, Brno
2
Published in:
Epidemiol. Mikrobiol. Imunol. 68, 2019, č. 1, s. 15-22
Category:
Original Papers
Overview
Aims:
Clostridium difficile (C. difficile) plays a minor but important role in paediatrics. The aims of this study were to objectivise data, to show their significance in clinical practice, and to present our experience with the treatment of paediatric patients.
Materials and methods:
A retrospective study was conducted in patients (0–19 years of age) hospitalized for Clostridium
difficile infection (CDI) in the Department of Paediatric Infectious Diseases, University Hospital in Brno between 2013 and 2017. Each patient was tested using a two-step diagnostic screening algorithm including immunochromatography and polymerase chain reaction assays.
Results:
Thirty-five patients with a median age of 10.3 years (range 1–17.5 years) were enrolled in the study. Almost 70% of patients were aged between 6 and 19 years. No risk factor was identified in one patient, 41.6% of cases were patients with malignancy or inflammatory bowel disease, and 2.5% of patients had short bowel syndrome. After targeted CDI treatment, the median time to resolution of diarrhoea was 2.5 days. Metronidazole was used in more than half of cases. Five patients received fidaxomicin, which was well tolerated. Metronidazole failed in three cases. Recurrence after incomplete treatment with metronidazole occurred in one patient. Health care-associated CDI was recorded in 86% of cases. Recurrent CDI was reported in four children (two with malignancy, one with inflammatory bowel dissease, and one with short bowel syndrome).
Conclusions:
The course of CDI is generally mild in the paediatric population. CDI without a risk factor is rare. Paediatric patients respond well to metronidazole. Fidaxomicin was well tolerated by all patients. We prefer the treatment with fidaxomicin in high-risk groups (immunocompromised condition, inflammatory bowel disease, and short bowel syndrome).
Keywords:
body mass index – diarrhoea – fidaxomicin – Clostridium difficile – Clostridium colitis
Sources
1. Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect Dis, 2014;20 Suppl 2:1–26.
2. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis, 2018;66(7):e1–48.
3. Beneš J, Husa P, Nyč O, et al. Diagnosis and therapy of Clostridium difficile infection: Czech national guidelines. Klin. Mikrobiol. Inf. Lek, 2014;20:56–66.
4. Borali E, Ortisi G, Moretti C, et al. Community-acquired Clostridium difficile infection in children: A retrospective study. J Ital Soc Gastroenterol Ital, 2015;47(10):842–846.
5. Antonara S, Leber AL. Diagnosis of Clostridium difficile Infections in Children. J Clin Microbiol, 2016;54(6):1425–1433.
6. Sammons JS, Toltzis P. Recent trends in the epidemiology and treatment of C. difficile infection in children. Curr Opin Pediatr, 2013;25(1):116–121.
7. van Dorp SM, Smajlović E, Knetsch CW, et al. Clinical and Microbiological Characteristics of Clostridium difficile Infection Among Hospitalized Children in the Netherlands. Clin Infect Dis, 2017;64(2):192–198.
8. Pai S, Aliyu SH, Enoch DA, et al. Five Years Experience of Clostridium difficile Infection in Children at a UK Tertiary Hospital: Proposed Criteria for Diagnosis and Management. PLOS ONE, 2012;7(12):e51728.
9. McFarland LV, Ozen M, Dinleyici EC, et al. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol, 2016;22(11):3078–3104.
10. Schutze GE, Willoughby RE. Clostridium difficile Infection in Infants and Children. Pediatrics, 2013;131(1):196–200.
11. Jangi S, Lamont JT. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutr, 2010;51(1):2–7.
12. Rousseau C, Lemée L, Le Monnier A, et al. Prevalence and diversity of Clostridium difficile strains in infants. J Med Microbiol, 2011;60(Pt 8):1112–1118.
13. Sathyendran V, McAuliffe GN, Swager T, et al. Clostridium difficile as a cause of healthcare-associated diarrhoea among children in Auckland, New Zealand: clinical and molecular epidemiology. Eur J Clin Microbiol Infect Dis, 2014 Oct;33(10):1741–1747.
14. Adlerberth I, Huang H, Lindberg E, et al. Toxin-producing Clostridium difficile strains as long-term gut colonizers in healthy infants. J Clin Microbiol, 2014;52(1):173–179.
15. Penders J, Vink C, Driessen C, et al. Quantification of Bifidobacterium spp., Escherichia coli and Clostridium difficile in faecal samples of breast-fed and formula-fed infants by real-time PCR. FEMS Microbiol Lett, 2005;243(1):141–147.
16. Nicholson MR, Thomsen IP, Edwards KM. Controversies Surrounding Clostridium difficile Infection in Infants and Young Children. Child Basel Switz, 2014;1(1):40–47.
17. Lees EA, Miyajima F, Pirmohamed M, et al. The role of Clostridium difficile in the paediatric and neonatal gut – a narrative review. Eur J Clin Microbiol Infect Dis, 2016;35(7):1047–1057.
18. Schäffler H, Breitrück A. Clostridium difficile – From Colonization to Infection. Front Microbiol, 2018;9:646.
19. Eglow R, Pothoulakis C, Itzkowitz S, et al. Diminished Clostridium difficile toxin A sensitivity in newborn rabbit ileum is associated with decreased toxin A receptor. J Clin Invest, 1992;90(3):822–829.
20. Rolfe RD. Binding kinetics of Clostridium difficile toxins A and B to intestinal brush border membranes from infant and adult hamsters. Infect Immun, 1991;59(4):1223–1230.
21. Keel MK, Songer JG. The distribution and density of Clostridium difficile toxin receptors on the intestinal mucosa of neonatal pigs. Vet Pathol, 2007;44(6):814–822.
22. Parsons SJ, Fenton E, Dargaville P. Clostridium difficile associated severe enterocolitis: a feature of Hirschsprung’s disease in a neonate presenting late. J Paediatr Child Health, 2005;41(12):689–690.
23. Mc Laughlin D, Friedmacher F, Puri P. The impact of Clostridium difficile on paediatric surgical practice: a systematic review. Pediatr Surg Int, 2014;30(8):853–859.
24. Nicholson MR, Thomsen IP, Slaughter JC, et al. Novel risk factors for recurrent Clostridium difficile infection in children. J Pediatr Gastroenterol Nutr, 2015;60(1):18–22.
25. Wendt JM, Cohen JA, Mu Y, et al. Clostridium difficile infection among children across diverse US geographic locations. Pediatrics, 2014;133(4):651–658.
26. Sammons JS, Toltzis P. Pitfalls in Diagnosis of Pediatric Clostridium difficile Infection. Infect Dis Clin North Am, 2015;29(3):465–476.
27. Kociolek LK, Patel SJ, Zheng X, et al. Clinical and Microbiologic Assessment of Cases of Pediatric Community-associated Clostridium difficile Infection Reveals Opportunities for Improved Testing Decisions. Pediatr Infect Dis J, 2016;35(2):157–161.
28. D’Ostroph AR, So T-Y. Treatment of pediatric Clostridium difficile infection: a review on treatment efficacy and economic value. Infect Drug Resist, 2017;10:365–375.
29. O’Gorman MA, Michaels MG, Kaplan SL, et al. Safety and Pharmacokinetic Study of Fidaxomicin in Children With Clostridium difficile-Associated Diarrhea: A Phase 2a Multicenter Clinical Trial. J Pediatr Infect Dis, 2017;31.
30. Nicholson MR, Crews JD, Starke JR, et al. Recurrent Clostridium difficile Infection in Children: Patient Risk Factors and Markers of Intestinal Inflammation. Pediatr Infect Dis J, 2017;36(4):379–383.
31. McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol, 2002;97(7):1769–1775.
32. Jacobson SM, Slain D. Evaluation of a bedside scoring system for predicting clinical cure and recurrence of Clostridium difficile infections. Am J Health-Syst Pharm, 2015;72(21):1871–1875.
Labels
Hygiene and epidemiology Medical virology Clinical microbiologyArticle was published in
Epidemiology, Microbiology, Immunology
2019 Issue 1
Most read in this issue
- Botulism – a rare but still present, life-threatening disease
- Progressive multifocal leukoencephalopathy – epidemiology, immune response, clinical differences, treatment
- Typhoid fever in the Czech Republic and an imported case after return from the Rainbow Gathering in Italy
- Clinical and microbiological characteristics of Clostridium difficile infection in children hospitalized at the Departement of Paediatric Infectious Diseases in Brno between 2013 and 2017