Paediatric Clostridium difficile infection: rarer than we think?

In view of the new IDSA clinical practice guidelines, we investigated C. difficile infection (CDI) rates and performance against the key standards in our infants and immunosuppressed paediatric patients.

Using electronic patient notes and microbiology systems, we collected data on every positive PCR result between June 2016 and March 2018 in our paediatric population. Information included risk factors, markers of severity and medical management.

48 samples were sent for C. difficile testing, from which 22 patients had positive results at an average age of 7.4 years. Only five samples were sent from patients under 2 year olds, of which four were PCR positive but toxin negative. Out of 22 positive patient samples, 9 were toxin positive. Risk factors for CDI included previous antibiotics or inpatient stay in the last 3 months, as well as recent PPI use. Only one patient had toxin positive CDI with severe disease. Overall the management of CDI in both toxin positive and negative patients was appropriate in terms of antibiotic choice and duration, and was tailored to specific patient circumstances. A high proportion of CDI patients were immunosuppressed or had recently undergone bone marrow transplants, but often showed no signs of severe infection (fever, raised inflammatory markers).

There should be a low threshold in testing patients who are immunosuppressed, as they are more likely to develop CDI. There were no toxin positive cases in patients under two years of age, which confirms that the test is not useful in this population.