Pediatr Gastroenterol Hepatol Nutr.  2014 Jun;17(2):80-84.

Clostridium difficile in Children: To Treat or Not to Treat?

• Shim JO

Abstract

Clostridium difficile infection has been increasing since 2000 in children and in adults. Frequent antibiotics use, comorbidity, and the development of hypervirulent strains have increased the risk of infection. Despite the high carriage rates of C. difficile, infants rarely develop clinical infection. Discontinuing antibiotics and supportive management usually leads to resolution of disease. Antibiotics use should be stratified depending on the patient's age and severity of the disease.

Keyword

Clostridium difficile; Child; Anti-bacterial agents

MeSH Terms

Adult
Anti-Bacterial Agents
Child*
Clostridium difficile*
Comorbidity
Humans
Infant
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Algorithm for management of children with unexplained diarrhea suspected Clostridium difficile infection.

Reference

1. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013; 108:478–498. quiz 99.

2. Seo GS. Clostridium difficile infection: what's new? Intest Res. 2013; 11:1–13.

3. Nylund CM, Goudie A, Garza JM, Fairbrother G, Cohen MB. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med. 2011; 165:451–457.

4. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2012; 107:89–95.

5. Thibault A, Miller MA, Gaese C. Risk factors for the development of Clostridium difficile-associated diarrhea during a hospital outbreak. Infect Control Hosp Epidemiol. 1991; 12:345–348.

6. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005; 366:1079–1084.

7. McFarland LV. Update on the changing epidemiology of Clostridium difficile-associated disease. Nat Clin Pract Gastroenterol Hepatol. 2008; 5:40–48.

8. Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, et al. ECDIS Study Group. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011; 377:63–73.

9. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Society for Healthcare Epidemiology of America. Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31:431–455.

10. Toltzis P, Kim J, Dul M, Zoltanski J, Smathers S, Zaoutis T. Presence of the epidemic North American Pulsed Field type 1 Clostridium difficile strain in hospitalized children. J Pediatr. 2009; 154:607–608.

11. Al-Jumaili IJ, Shibley M, Lishman AH, Record CO. Incidence and origin of Clostridium difficile in neonates. J Clin Microbiol. 1984; 19:77–78.

12. Bryant K, McDonald LC. Clostridium difficile infections in children. Pediatr Infect Dis J. 2009; 28:145–146.

13. Chang JY, Shim JO, Ko JS, Seo JK, Lee JA, Kim HS, et al. Monitoring of Clostridium difficile Colonization in Preterm Infants in Neonatal Intensive Care Units. Pediatr Gastroenterol Hepatol Nutr. 2012; 15:29–37.

14. Eglow R, Pothoulakis C, Itzkowitz S, Israel EJ, O'Keane CJ, Gong D, et al. Diminished Clostridium difficile toxin A sensitivity in newborn rabbit ileum is associated with decreased toxin A receptor. J Clin Invest. 1992; 90:822–829.

15. El Feghaly RE, Stauber JL, Tarr PI, Haslam DB. Viral co-infections are common and are associated with higher bacterial burden in children with clostridium difficile infection. J Pediatr Gastroenterol Nutr. 2013; 57:813–816.

16. Deshpande A, Pant C, Pasupuleti V, Rolston DD, Jain A, Deshpande N, et al. Association between proton pump inhibitor therapy and Clostridium difficile infection in a meta-analysis. Clin Gastroenterol Hepatol. 2012; 10:225–233.

17. Toltzis P, Nerandzic MM, Saade E, O'Riordan MA, Smathers S, Zaoutis T, et al. High proportion of false-positive Clostridium difficile enzyme immunoassays for toxin A and B in pediatric patients. Infect Control Hosp Epidemiol. 2012; 33:175–179.

18. Johnson S, Homann SR, Bettin KM, Quick JN, Clabots CR, Peterson LR, et al. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med. 1992; 117:297–302.

19. Pant C, Deshpande A, Altaf MA, Minocha A, Sferra TJ. Clostridium difficile infection in children: a comprehensive review. Curr Med Res Opin. 2013; 29:967–984.

20. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007; 45:302–307.

21. Jardin CG, Palmer HR, Shah DN, Le F, Beyda ND, Jiang Z, et al. Assessment of treatment patterns and patient outcomes before vs after implementation of a severity-based Clostridium difficile infection treatment policy. J Hosp Infect. 2013; 85:28–32.

22. Pai S, Aliyu SH, Enoch DA, Karas JA. Five years experience of Clostridium difficile infection in children at a UK tertiary hospital: proposed criteria for diagnosis and management. PLoS One. 2012; 7:e51728.

23. Schutze GE, Willoughby RE. Committee on Infectious Diseases. American Academy of Pediatrics. Clostridium difficile infection in infants and children. Pediatrics. 2013; 131:196–200.

24. Johnston BC, Ma SS, Goldenberg JZ, Thorlund K, Vandvik PO, Loeb M, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012; 157:878–888.

25. van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013; 368:407–415.