Clostridioides difficile, a primary cause of antibiotic-associated diarrhea, presents a spectrum of clinical manifestations. While less prevalent in children than adults, the incidence of pediatric Clostridioides difficile infection (CDI) is on the rise. The 33rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2023) dedicated a session to shed light on this pressing issue, with Dr. Anne J. Gonzales-Luna from the University of Houston College of Pharmacy offering her expertise.
Causes of Pediatric CDI:
Clostridioides difficile is a bacterium causing gastrointestinal infections. After colonizing patients, it induces disease in susceptible hosts. The bacterium produces toxins which lead to symptoms like diarrhea and abdominal pain. The infection’s pathophysiology remains consistent in adults and children. However, the risk factors vary: age and antibiotic exposure in adults, while immunodeficiencies or chronic gastrointestinal diseases in children.
Treatment Recommendations:
U.S guidelines by IDSA-SHEA and European guidelines from 2014 provide insights into CDI treatment in children. Initially, metronidazole and vancomycin were equally recommended. A more recent randomized trial comparing vancomycin and fidaxomicin found the latter to have a higher global cure rate, marking its significance in pediatric treatment.
Challenges in Pediatric CDI Treatment:
The paramount challenge in treating children is the correct diagnosis. With children under 1 or 2 years showcasing high asymptomatic colonization rates, diagnostic tools may lead to overestimations of CDI incidence. This complication makes clinical trials challenging and undermines the existing evidence base.
Summary:
The increasing rate of pediatric CDI demands attention. With advancements in treatment recommendations and diagnostic tools, there’s hope for better management. However, correct diagnosis remains crucial. Ensuring the accurate identification and subsequent treatment of CDI in children is a pressing concern that the medical community must continue to address.
Dr. Anne J. Gonzales-Luna University of Houston College of Pharmacy
