Diagnosis of Clostridium difficile Infections in Children

Antonara, Stella; Leber, Amy

doi:10.1128/jcm.03014-15

Cited by 38 publications

(25 citation statements)

References 47 publications

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“…Severe complications of CDI, such as fulminant CDI or pseudomembranous colitis, are not common among children [ 16 – 18 ]. Neither Antonara et al [ 17 ] nor Chakrabarti et al observed severe CDI or death attributing to CDI [ 20 ]. Contrary, in the other study of 37 patients, the increased risk of death was evaluated at 180 days and restricted to patients with severe CDI (57% of patients) [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

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Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation

Salamonowicz

Ociepa

Frączkiewicz

et al. 2018

Eur J Clin Microbiol Infect Dis

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Clostridium difficile infection (CDI) is one of the most common causes of nosocomial infectious diarrhea in children during anticancer therapy or undergoing hematopoietic stem cell transplantation (HSCT) in Europe. Immunosuppression in these patients is a risk factor for CDI. Malignant diseases, age, acute graft-versus-host disease (aGVHD), HLA mismatch, or use of total body irradiation may play an important role in CDI course. The aim of this study was to evaluate the incidence, course, and outcome of CDI in children treated for malignancy or undergoing HSCT. Between 2012 and 2015, a total number of 1846 patients were treated for malignancy in Polish pediatric oncological centers (PHO group) and 342 underwent transplantation (HSCT group). In PHO group, episodes of CDI occurred in 210 patients (14%). The incidence of CDI was higher in patients with hematological malignancies in comparison to that with solid tumors. Patients with acute myeloblastic leukemia had shorter time to episode of CDI than those with acute lymphoblastic leukemia. Patients over 5 years and treated for acute leukemia had more severe clinical course of disease in PHO group. In HSCT group, CDI occurred in 29 (8%) patients. The incidence of CDI was higher in patients transplanted for acute leukemia. The recurrence rate was 14.7% in PHO and 20.7% in HSCT patients. CDI incidence was highest in patients with hematological malignancies. Most of patients experienced mild CDI. Age < 5 years and diagnosis other than acute leukemia were the positive prognostic factors influencing clinical CDI course.

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Section: Discussionmentioning

confidence: 99%

“…Severe CDI course was defined by CDI first-line treatment failure which meant lack of improvement in stool consistency after 3 days, the need to add the second drug, new signs of severe colitis, the need of admission to an intensive care unit, and/or death related to CDI [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation

Salamonowicz

Ociepa

Frączkiewicz

et al. 2018

Eur J Clin Microbiol Infect Dis

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“…[20] In older children, increasing CDI rates have been documented in some settings. [20,21] This study has demonstrated that the overall reported CDI incidence rate decreased with the introduction of a two-step algorithm for laboratory diagnosis of CDI. Standardisation of laboratory testing methodology and CDI incidence rate reporting is required in order to yield robust data.…”

Section: Research Discussionmentioning

confidence: 91%

The impact of diagnostic methods on the diagnosis of Clostridiodes difficile infection

Nomlomo

Nana

2020

S Afr Med J

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Clostridiodes difficile is a common cause of healthcare-associated diarrhoea. The clinical outcome depends on host factors and the virulence of the toxin-producing strain. This organism causes disease that ranges in severity from asymptomatic colonisation to severe diarrhoea, pseudomembranous colitis, toxic megacolon, colonic perforation and death. [1-3] The principal risk factor for C. difficile infection (CDI) is prior antibiotic therapy. [4] Results of a systematic review assessing the epidemiology of CDI in low and middle Human Development Index countries show that there is a paucity of published literature describing the epidemiology and burden of CDI. [2] Rajabally et al. [1,3] highlight that data relating to the burden of C. difficile-associated disease (CDAD) in southern Africa are limited. The study conducted by this group emphasises that the magnitude of the CDI burden in South African (SA) hospitals is not known. [1,3] Freeman et al. [5] note the two key issues that hinder understanding of the epidemiology of CDI. Firstly, there is poor recognition and documentation of CDAD. [5] The second obstacle is the many different approaches to the laboratory diagnosis of CDI. This is a dilemma also encountered in SA. [5] There are numerous targets and combinations of targets that can be used to detect C. difficile (cell cytotoxicity assays (CCAs), toxigenic culture, glutamate dehydrogenase (GDH), toxins through enzyme immunoassay (EIA), and toxin genes through polymerase chain reaction (PCR)). Researchers in the UK have noted a variation in the reference standards for CDI diagnosis. This variation gives rise to differences in assessment of the diagnostic performance of assays and contributes to uncertainty in diagnosing CDI. [6,7] It is therefore likely that the measured incidence of infection will vary according to the laboratory diagnostic method used. [5-7] PCR-based testing is unable to differentiate between infection and colonisation. As a result, reliance on it as a stand-alone test may result in over-diagnosis of CDI. [3] The low sensitivity of toxin EIAs also makes these unsuitable as stand-alone tests. [3,6] For this reason, an algorithm that includes a sensitive assay (GDH or PCR) followed by a specific assay (toxin detection) may provide more accurate results. [8] The Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) all recommend the use of multistep algorithms for the diagnosis of CDI. [8,9] These algorithms allow reliable exclusion of CDI without additional tests if the GDH screen or PCR is negative, [8] reducing the turnaround time significantly while providing accurate results. [8,9] Objectives Prior to July 2016, the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Microbiology Laboratory used stand-alone PCR and stand-alone toxin EIA for CDI diagnosis. Currently, a two-step algorithm for CDI diagnosis is used. A rapid EIA for GDH and toxin A/B is the i...

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“…As a discussion of C difficile testing is outside the scope of this article, the authors refer readers to a review of C difficile testing in pediatrics. 40…”

Section: Detection Of Gastrointestinal Pathogensmentioning

confidence: 99%

New Developments in Rapid Diagnostic Testing for Children

Gonzalez

McElvania

2018

Infectious Disease Clinics of North America

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The advent of new diagnostics assays for Group A Streptococcus, influenza, and respiratory syncytial virus now provide rapid results with increased sensitivity and specificity. Molecular testing is no longer confined to the walls of the laboratory, but moving to the patient in the form of point-of-care tests. In addition, multiplex syndromic panels are allowing broad testing of pathogens associated with a single clinical presentation. This article focuses specifically on rapid diagnostic tests for pathogens most affecting children. Rapid and accurate pathogen detection in children may result in decreased time to optimal antimicrobial treatment and improved patient outcomes.

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Diagnosis of Clostridium difficile Infections in Children

Cited by 38 publications

References 47 publications

Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation

Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation

The impact of diagnostic methods on the diagnosis of Clostridiodes difficile infection

New Developments in Rapid Diagnostic Testing for Children

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