Severe clinical outcome is uncommon in Clostridium difficile infection in children: a retrospective cohort study

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• 作者：Kevin L Schwartz (9)
  Ilyse Darwish (6)
  Susan E Richardson (7)
  Michael R Mulvey (8)
  Nisha Thampi (9) (9)
  
• 关键词：Clostridium difficile ; North American pulsed ; field type ; Pediatrics ; Child
• 刊名：BMC Pediatrics
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：167 KB
• 作者单位：Kevin L Schwartz (9)
  Ilyse Darwish (6)
  Susan E Richardson (7)
  Michael R Mulvey (8)
  Nisha Thampi (9) (9)
  
  9. Division of Infectious Diseases, Mount Sinai Hospital, University of Toronto, Toronto, Canada
  6. Sandra A. Rotman Laboratories, University Health Network, University of Toronto, Toronto, ON, Canada
  7. Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  8. National Microbiology Laboratory, Winnipeg, MB, Canada
  
• ISSN：1471-2431

文摘

Background Clostridium difficile infection (CDI) is the most common cause of health care–associated diarrhea in children and adults. Although serious complications of CDI have been reported to be increasing in adults, this trend has not yet been demonstrated in children. The purpose of this study was to examine the features of CDI in a pediatric population, with special attention to the occurrence of CDI-related severe outcomes. Methods A chart review was conducted for patients with C. difficile infection detected by cytotoxin assay between August, 2008 and July, 2012. Basic demographics, mode of acquisition (nosocomial versus community), laboratory and clinical features, treatment, and outcome data were collected. Pulsed-field gel electrophoresis and polymerase chain reaction detection of toxin A (tcdA), toxin B (tcdB), binary toxin (cdtB) and tcdC genes were performed on isolates from nosocomial cases by the National Microbiology Laboratory, Winnipeg, Manitoba. Results Ninety percent of children with CDI experienced resolution of symptoms by 30 days after disease onset and 2% experienced a severe outcome. There were no cases where colectomy was performed for CDI, and only one case where CDI contributed to death. Various combinations of clinical and laboratory features were not predictive of a severe outcome. Seventy-four percent of cases were nosocomial-associated. Among all cultured strains, the NAP4 strain occurred most frequently (24%), followed by NAP1 (11%). There was no association between strain type and clinical outcome; however, relapses were significantly more frequent in NAP4-infected children. Conclusions Severe outcomes due to CDI are uncommon in children compared to adults. Further prospective pediatric studies on CDI in community and hospital settings are required to better understand risk factors, optimal treatment and the significance of NAP4 in pediatric CDI.