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

• Published in: European journal of clinical microbiology & infectious diseases 2017, Vol.36 (1), p.177-185
• Main Authors: Lo Vecchio, A., Lancella, L., Tagliabue, C., De Giacomo, C., Garazzino, S., Mainetti, M., Cursi, L., Borali, E., De Vita, M. V., Boccuzzi, E., Castellazzi, L., Esposito, S., Guarino, A.
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biomedical and Life Sciences; Biomedicine; Child; Child, Preschool; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium Infections - drug therapy; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Clostridium Infections - pathology; Diarrhea - drug therapy; Diarrhea - epidemiology; Diarrhea - microbiology; Diarrhea - pathology; Enzymes; Epidemiology; Female; Hospitals; Humans; Infant; Infant, Newborn; Infections; Infectious diseases; Inflammatory bowel disease; Internal Medicine; Investigations; Italy - epidemiology; Male; Medical Microbiology; Metronidazole - therapeutic use; Original Article; Patient admissions; Pediatrics; Prevalence; Recurrence; Retrospective Studies; Risk Assessment; Risk factors; Toxins; Treatment Outcome; Vancomycin - therapeutic use
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-016-2793-7

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.