Five Years Experience of Clostridium difficile Infection in Children at a UK Tertiary Hospital: Proposed Criteria for Diagnosis and Management

Autor: J. A. Karas, David A Enoch, Sani Hussaini Aliyu, Sumita Pai
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Bacterial Diseases
Male
Pediatrics
Time Factors
lcsh:Medicine
Comorbidity
Tertiary Care Centers
Risk Factors
Medicine
Gastrointestinal Infections
Young adult
lcsh:Science
Child
Cross Infection
Multidisciplinary
Child Health
Clostridium difficile
Prognosis
Bacterial Pathogens
Anti-Bacterial Agents
Hospitalization
Diarrhea
Infectious Diseases
Research Design
Child
Preschool
Cohort
Vancomycin
Pediatric Gastroenterology
Female
Public Health
medicine.symptom
medicine.drug
Research Article
Adult
medicine.medical_specialty
Infectious Disease Control
Adolescent
Clinical Research Design
Clostridium Difficile
Microbiology
Young Adult
Intensive care
Humans
Biology
Retrospective Studies
business.industry
Clostridioides difficile
lcsh:R
Infant
Newborn
Infant
Retrospective cohort study
Pseudomembranous colitis
United Kingdom
Clostridium Infections
lcsh:Q
business
Zdroj: PLoS ONE
PLoS ONE, Vol 7, Iss 12, p e51728 (2012)
ISSN: 1932-6203
Popis: Background Clostridium difficile infection (CDI) is associated with significant morbidity and mortality in adults. There is increasing evidence of the pathogenic role of C. difficile in the paediatric population. We sought to ascertain the clinical presentation and severity of CDI in children at our institution and develop criteria to aid management. Methods Clinical data was retrospectively collected from all children (0-16 yrs) with a positive C. difficile toxin result over a 5-year period. National adult guidelines were used to assess the severity and management of CDI. Results Seventy-five patients were included with a mean age of 2.97 years. Forty-nine were hospital onset, 22 community onset and 4 healthcare-associated. The most common co-morbidity among the hospital onset infections was malignancy. Gastrointestinal conditions were most common among community onset infections. Fifty-five cases (73.3%) had received antibiotics in the preceding month, 7 (9.3%) had cow's milk intolerance and 9 (12%) had co-infection with another gut pathogen. According to national adult guidelines 57 cases (76%) were categorised as severe. Thirty cases received oral metronidazole, two patients required intensive care and one patient had a sub-total colectomy for pseudomembranous colitis. No mortality was observed. Discussion We confirm the association of paediatric CDI with co-morbidities such as haematological and solid organ malignancies, recent antibiotic use and hospitalisation. We observed an association between cows milk protein intolerance and C. difficile. The use of adult criteria overestimated severity of disease in this cohort, as most cases experienced a mild course of illness with low morbidity and no mortality. This indicates that adult scoring criteria are not useful in guiding management and we propose specific criteria for children.
Databáze: OpenAIRE
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