Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country

Eur J Clin Microbiol Infect Dis. 2017 Jan;36(1):177-185. doi: 10.1007/s10096-016-2793-7. Epub 2016 Sep 30.

Abstract

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Clostridium Infections / drug therapy
  • Clostridium Infections / epidemiology*
  • Clostridium Infections / microbiology
  • Clostridium Infections / pathology
  • Clostridium difficile / isolation & purification*
  • Diarrhea / drug therapy
  • Diarrhea / epidemiology*
  • Diarrhea / microbiology
  • Diarrhea / pathology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Italy / epidemiology
  • Male
  • Metronidazole / therapeutic use
  • Prevalence
  • Recurrence
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome
  • Vancomycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Metronidazole
  • Vancomycin