Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Clostridium difficile in Children: To Treat or Not to Treat?

  • Shim, Jung Ok (Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine)
  • Received : 2014.06.13
  • Accepted : 2014.06.26
  • Published : 2014.06.30
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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.

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References

  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: 478-98; quiz 99. https://doi.org/10.1038/ajg.2013.4
  2. Seo GS. Clostridium difficile infection: what's new? Intest Res 2013;11:1-13. https://doi.org/10.5217/ir.2013.11.1.1
  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;165:451-7.
  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. https://doi.org/10.1038/ajg.2011.398
  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;12:345-8. https://doi.org/10.2307/30145209
  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;366:1079-84. https://doi.org/10.1016/S0140-6736(05)67420-X
  7. McFarland LV. Update on the changing epidemiology of Clostridium difficile-associated disease. Nat Clin Pract Gastroenterol Hepatol 2008;5:40-8. https://doi.org/10.1038/ncpgasthep1029
  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. https://doi.org/10.1016/S0140-6736(10)61266-4
  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;31:431-55. https://doi.org/10.1086/651706
  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;154:607-8. https://doi.org/10.1016/j.jpeds.2008.10.016
  11. Al-Jumaili IJ, Shibley M, Lishman AH, Record CO. Incidence and origin of Clostridium difficile in neonates. J Clin Microbiol 1984;19:77-8.
  12. Bryant K, McDonald LC. Clostridium difficile infections in children. Pediatr Infect Dis J 2009;28:145-6. https://doi.org/10.1097/INF.0b013e318198c984
  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. https://doi.org/10.5223/pghn.2012.15.1.29
  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;90:822-9. https://doi.org/10.1172/JCI115957
  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;57:813-6. https://doi.org/10.1097/MPG.0b013e3182a3202f
  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;10:225-33. https://doi.org/10.1016/j.cgh.2011.09.030
  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;33:175-9. https://doi.org/10.1086/663706
  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. https://doi.org/10.7326/0003-4819-117-4-297
  19. Pant C, Deshpande A, Altaf MA, Minocha A, Sferra TJ. Clostridium difficile infection in children: a comprehensive review. Curr Med Res Opin 2013;29:967-84. https://doi.org/10.1185/03007995.2013.803058
  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;45:302-7. https://doi.org/10.1086/519265
  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. https://doi.org/10.1016/j.jhin.2013.04.017
  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. https://doi.org/10.1371/journal.pone.0051728
  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. https://doi.org/10.1542/peds.2012-2992
  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;157:878-88. https://doi.org/10.7326/0003-4819-157-12-201212180-00563
  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;368:407-15. https://doi.org/10.1056/NEJMoa1205037

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