![]() ![]() It has been suggested that the relative risk of therapy with a given antimicrobial agent and its association with CDI depends on the local prevalence of strains that are highly resistant to the antimicrobial being used such agents increase the risk for CDI by suppressing the growth of susceptible microbial flora. Virtually all antimicrobials used in humans have been associated with CDI, including those used for surgical prophylaxis. The recurrent infection rate is similar to rates reported in adults (approximately 25%). Among children with severe disease, complications are infrequent. Duration of hospital stay, older age and exposure to multiple antibiotic classes are risk factors for paediatric CDI. In the United States, an increase in CDI incidence has been observed among hospitalized children. A history of therapy with antibiotics or antineoplastic agents is present in most adult patients with CDI. The incubation period from exposure to onset of symptomatic C difficile infection (CDI) is an estimated median of two to three days. Infants and young children rarely develop symptoms, possibly because of immature surface receptors for these microbes, and because they are protected by maternal antibodies acquired transplacentally or in breast milk. It is estimated that 15% to 63% of neonates, 3% to 33% of infants and toddlers younger than two years of age, and up to 8.3% of children older than two years of age are asymptomatic carriers. ![]() Infants and children are significantly more likely to carry C difficile asymptomatically in the gastrointestinal (GI) tract than are adults. Spores are transferred to patients mainly on the hands of health care staff who have touched a contaminated surface or item. Person-to-person spread by the fecal-oral route is the primary mode of transmission, with health care facilities being a notably common and problematic setting for infection. Key Words: CDI Colitis Diarrhea Immunocompromise Megacolon Metronidazole NAP1 Vancomycin Epidemiology and risk factorsĬlostridium difficile is a spore-forming bacterium found in soil, hospital environments, child care facilities and nursing homes. This statement replaces a previous Canadian Paediatric Society position statement on C difficile published in 2000. The importance of antimicrobial stewardship as a preventive strategy is highlighted. The relationship between age and disease severity in children with a newly emergent and more fluoroqinolone-resistant strain of C difficile (North American Pulse-field type-1 ) remains unknown. Significant differences between adult and paediatric risk factors and disease are discussed, along with emerging therapies. The present statement, targeted at clinicians caring for infants and children in community and institutional settings, summarizes the relevant information relating to the role of C difficile in childhood diarrhea and provides recommendations for diagnosis, prevention and treatment. Upton D Allen Canadian Paediatric Society Infectious Diseases and Immunization CommitteeĪn increase in Clostridium difficile infection incidence has been observed among hospitalized children in the United States. ![]()
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