Infectious Disease

Extensive analysis shows that asymptomatic C. difficile is the most common in infants

August 30, 2021

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Among asymptomatic children, the prevalence of Clostridioides difficile is highest in infants between the ages of 6 and 12 months, according to the results of a symptomatic review and meta-analysis published in JAMA Pediatrics.

C. difficile was detected in more than 40% of infants aged 6 to 12 months – although the rate of toxigenic C. difficile was much lower – and was far less common in children aged 5 to 18 years. The researchers said the results of the analysis could “provide a context for interpreting C. difficile test results in young children.”

The CDC estimates that C. difficile causes over half a million infections in the United States each year. A 2018 study published in Clinical Infectious Diseases found that the incidence of C. difficile in children has increased since 2000 – mainly in children in community and outpatient settings, but also in non-hospitalized children.

Stephen B. Freedman, MDCM, MSc, Professor of Pediatrics and Emergency Medicine at Alberta Children’s Hospital and the University of Calgary Cumming School of Medicine, said in an interview with Healio that the idea for the current study came from the observation that clinicians see increasingly positive test results for C. difficult.

Stephen B. Freedman

“We wanted to find out how often C. difficile is detected and present when it is not actually pathogenic,” Freedman said.

Freedman and colleagues reviewed 95 studies from around the world involving over 19,000 pediatric patients and found that detection rates of toxigenic or non-toxigenic C. difficile were highest in infants aged 6 to 12 months (41% ; 95% CI, 32% -50.). %) and decreased to 12% in children aged 5 to 18 years (95% CI, 7% -18%).

The prevalence of toxigenic C. difficile colonization was lower, peaking in infants aged 6 to 12 months of 14% (95% CI, 8% – 21%) and decreasing to 6% (95% CI, 2% – 11%) among children older than 5 years.

Freedman said the results speak of the importance of putting C. difficile test results in context.

“If you just react to the test result, you will treat many children as if they had C. difficile infection when in reality they did not, and this usually leads to overuse of broad spectrum antibiotics. “Said Freedman.

In the meantime, Freedman said, providers and parents should be aware of the dangers of ineffective testing.

“I think it’s important … to understand that detecting C. difficile itself does not mean infection,” Freedman said. “[It is also important to clarify] … whether treatment is indicated for an infection. The vast majority of tests are less likely to indicate real infection in children. “

References:

CDC. C. diff (Clostridioides difficile). https://www.cdc.gov/cdiff/index.html. Accessed August 27, 2021.

McDonald, LC, et. al, Clin Infect Dis. 2018; doi: 10.1093 / cid / cix1085.

Tougas SR et al. JAMA Pediatrics. 2021; doi: 10.1001 / jamapediatrics.2021.2328.

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