Journal of Gastrointestinal Infections

Register      Login

VOLUME 8 , ISSUE 1 ( December, 2018 ) > List of Articles

ORIGINAL ARTICLE

Pediatric Prevalence of Clostridium difficile Infection in a Tertiary Care Hospital

Chetana Vaishnavi, Babu R Thapa

Keywords : Antibiotics, C. difficile infection, Clinical symptoms, Follow-up, Pediatric patients.

Citation Information : Vaishnavi C, Thapa BR. Pediatric Prevalence of Clostridium difficile Infection in a Tertiary Care Hospital. J Gastrointest Infect 2018; 8 (1):5-11.

DOI: 10.5005/jp-journals-10068-0013

License: CC BY-NC 4.0

Published Online: 00-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and objectives: Clostridium difficile is the etiological agent of healthcare-associated infections in adults. Recently, C. difficile is being considered as a gastrointestinal pathogen in pediatric patients. A retrospective investigation was carried out in a tertiary care hospital to look for the pediatric prevalence of C. difficile infection (CDI) in different age groups. Materials and methods: The patient population investigated for CDI was categorized into infant group (0–2 years), early childhood group (<2–12 years) and teenage group (<12–19 years). Clinical and demographic information were retrieved from laboratory records. Results: A data of 1033 patients (0–19 years; M:F = 667:366) the male gender was significant (p < 0.0001). Statistical significance (p < 0.0001) was observed between the three age groups (infant group, n = 241; early childhood group, n = 424; teenage group, n = 368). The major underlying ailments were gastrointestinal symptoms (31.9%) and malignancies (24.2%). C. difficile toxin (CDT) was positive in 22.07%, and significant (p = 0.000) in all the groups. Clinical symptoms were bloody diarrhea (9.87%), watery diarrhea (57.31%), fever (53.05%) and abdominal pain (34.56%). The frequency of diarrhea was significant (p > 0.0001). Antibiotic use with clinical symptoms showed significance with watery diarrhea (p = 0.000) and fever (p = 0.000). Abdominal pain was found to be significant (p = 0.007) when correlated with CDT positivity. The CDI was positive in a total of 46 (27%) patients on first follow-up (n = 170). When variables of patients in the repeat follow-up (n = 47) were compared with their primary admission data and that of first follow-up, significant difference was seen. Conclusion: The CDI is commonly present in hospitalized pediatric patients, but clinical symptoms and suspicion can aid the final diagnosis.


PDF Share
  1. Mallavarapu R K, Katner, HP. Clostridium difficile–associated diarrhea and colitis in the hospitalized patient; Hospital Physician. Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Hospital Physician July 2007;5: 21-27.
  2. George WL. Antimicrobial Agent–Associated Diarrhea in Adult Humans. In Clostridium difficile 1988 Jan 1 pp. 31-44.
  3. Vaishnavi, C. Clinical spectrum and pathogenesis of Clostridium difficile associated diseases. Indian J Med Res 2010; 131: 487-499.
  4. Vaishnavi C. Clostridium difficile associated disease. In: Infections of the gastrointestinal system. Ed. Vaishnavi C. Jaypee Brothers Medical Publishers. 2013. Pp 87-108.
  5. Stark PL, Lee AD, Parsonage BD. Colonization of the large bowel by Clostridium difficile in healthy infants: quantitative study. Infection and immunity. 1982 Mar 1;35(3):895-899.
  6. Viscidi R, Willey S, Bartlett JG. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterol. 1981;81:5-9.
  7. Pothoulakis C, Lamont JT. Microbes and microbial toxins: paradigms for microbial- mucosal interactions II. The integrated response of the intestine to Clostridium difficile toxins. Am J Physiol Gastrointest Liver Physiol. 2001;280(2):G178-G183.
  8. Vaishnavi C, Thapa BR, Thennarasu K, Singh K. Faecal lactoferrin assay as an adjunct to Clostridium difficile diarrhoea. Indian J Pathol Microbiol. 2002;45(1):69-73.
  9. Larson HE, Price AB, Honour P, Borriello SP. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet; 1978 May 20;1(8073):1063-1066.
  10. Cashore WJ, Peter G, Lauermann M, Stonestreet BS, Oh W. Clostridia colonization and clostridial toxin in neonatal necrotizing enterocolitis. J Pediatr.1981;98(2):308-311.
  11. Adler SP, Chandrika T, Berman WF. Clostridium difficile associated with pseudomembranous colitis. Occurrence in a 12-week-old infant without prior antibiotic therapy. Am J Dis Child.1981;135(9):820-822.
  12. Donta ST, Myers MG. Clostridium difficile toxin in asymptomatic neonates. J Pediatr. 1982;100(3):431-434.
  13. Vaishnavi C. Established and potential risk factors for Clostridium difficile infection. Indian J Med Microbiol. 2009 27:291-302.
  14. Dominguez SR, Dolan SA, West K, Dantes RB, Epson E, et al. High colonization rate and prolonged shedding of Clostridium difficile in pediatric oncology patients. Clin Infect Dis. 2014;29;59(3):401-403.
  15. Vaishnavi C, Singh M, Kapoor P, Kochhar R. Clinical and demographic profile of patients reporting for Clostridium difficile infection in a tertiary care hospital. Indian J Med Microbiol. 2015;33:326-327.
  16. Jangi S, Lamont JT. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutr. 2010;51(1):27.
  17. Hall IC, O'Toole E. Intestinal flora in newborn infants with a description of a new pathogenic anaerobe, Bacillus difficilis. Am J Dis Child. 1935;49:390-402.
  18. Richardson SA, Alcock PA, Gray J. Clostridium difficile and its toxin in healthy neonates. BMJ (Clin Res Ed).1983;287:878.
  19. Han VK, Sayed H, Chance GW, Brabyn DG, Shaheed WA. An outbreak of Clostridium difficile necrotizing enterocolitis: a case for oral vancomycin therapy? 1983;71(6):935-941.
  20. Sutphen JL, Grand RJ, Flores A, Chang TW, Bartlett JG. Chronic diarrhea associated with Clostridium difficile in children. Am J Dis Child.1983;137(3):275-278.
  21. Dubberke ER, Gerding DN, Classen D, Arias M K, Podgorny K. Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 (suppl 1): S81-S92.
  22. Kim J, Smathers SA, Prasad P, Leckerman KH, Coffin S, Zaoutis T. Epidemiological features of Clostridium difficile – associated disease among inpatients at children’s hospitals in the United States, 2001–2006. Pediatrics; 2008; 122(6):1266-1270.
  23. Zilberberg MD, Tillotson GS, McDonald C. Clostridium difficile infections among hospitalized children, United States, 1997-2006. Emerg Infect Dis. 2010 Apr;16(4):604.
  24. 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.
  25. Deshpande A, Pant C, Anderson MP, Donskey CJ, Sferra TJ. Clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence. Pediatr Infect Dis 2013;32:1138.
  26. Boenning DA, Fleisher GR, Campos JM, Hulkower CW, Quinlan RW. Clostridium difficile in a pediatric outpatient population. Pediatr Infect Dis. 1982;1(5):336-338.
  27. Mårdh PA, Helin I, Colleen I, Oberg M, Holst E. Clostridium difficile toxin in faecal specimens of healthy children and children with diarrhoea. Acta Paediatr Scand. 1982; 71(2):275-278.
  28. Ellis ME, Mandal BK, Dunbar EM, Bundell KR. Clostridium difficile and its cytotoxin in infants admitted to hospital with infectious gastroenteritis. BMJ (Clin Res Ed). 1984;18: 288(6416):524-526.
  29. Kim K, DuPont HL, Pickering LK. Outbreaks of diarrhea associated with Clostridium difficile and its toxin in day-care centers: evidence of person-to-person spread. J Pediatr. 1983; 102(3):376-382.
  30. Vesikari T, Isolauri E, Mäki M, Grönroos P. Clostridium difficile in young children. As- sociation with antibiotic usage. Acta Paediatr Scand. 1984;73(1):86-91.
  31. Cerquetti M, Luzzi I, Caprioli A, Sebastianelli A, Mastrantonio P. Role of Clostridium difficile in childhood diarrhea. Pediatr Infect Dis J. 1995;14(7):598-603.
  32. Crew J. Clostridium difficile infection in children: Clinical features and diagnosis. In Eds. Edwards, MS, Torchia, MM, Up to date, 2018.
  33. Boyle, NM, Magaret A, Stednick Z, Morrison A, Butler-Wu, S, Zerr D et al. Evaluating risk factors for Clostridium difficile infection in adult and pediatric hematopoietic cell transplant recipients. Antimicrobial resistance and infection control. 2015;4(1):41.
  34. Sammons JS, Toltzis P, Zaoutis TE. Clostridium difficile infection in children. JAMA Pediatr. 2013;167(6):567-573
  35. Stephen M. Management of bloody diarrhea in children in primary care. BMJ. 2008;336:1010-1015.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.