Clostridioides (Clostridium) difficile carriage in asymptomatic children since 2010: a narrative review

Boyanova, Lyudmila; Kalvatchev, Nikolay; Yordanov, Daniel; Hadzhiyski, Petyo; Markovska, Rumyana; Gergova, Galina; Mitov, Ivan

doi:10.1080/13102818.2019.1650666

Cited by 3 publications

(13 citation statements)

References 48 publications

(86 reference statements)

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“…Age groups included neonates (n = 13); infants (n = 24); and children 2 years or younger (n = 12), 3 years or younger (n = 3), 5 years or younger (n = 2), 8 years or younger (n = 2), 10 years or younger (n = 1), and older than 10 years (n = 32) . Seventy-seven studies included healthy children; other populations were premature or low-birth-weight infants (n = 6), patients with oncologic or hematologic disease (n = 9), patients with a diagnosis of malnourishment (n = 1), and outpatients attending gastroenterology clinics without C difficile –associated clinical symptoms (n = 2) (eTable 2 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…Age groups included neonates (n = 13) 37,39,48,51,55,56,58,61,66,69,77,80,85,86,96 ; infants (n = 24) 15, 36,43,49,54,63,65,72,73,81,83,84,89,97,101,102,111,113,114,116,120,125; and children 2 years or younger (n = 12), 35,42,57,59,71,90,91,94,98,104,105,112 3 years or younger (n = 3), 5 years or younger (n = 2), 41,99 8 years or younger (n = 2), 100,122 10 years or younger (n = 1), and older than 10 years (n = 32). 16,17,38,40,[44][45][46][47]52,53,60,62,64,67,70,[74][75][76]78,82,93,103,[106][107][108][109][110]117,119,121,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eleven studies had a high risk of bias because of failure to describe the participants or setting in detail (eg, hospitalized children without admission diagnoses). [45][46][47]55,62,64,70,94,107,118,121 High statistical analysis risk of bias was assigned to 3 studies 42,112,116 with discrepant prevalence rates between written and numerical reports. Unclear risk of bias was assigned to 1 study 91 in which the prevalence rate reported over time was unclear.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Studies with homogenous populations (n = 5) were deemed to be nonapplicable to this category. 66,69,70,72,121 For objective identification of subpopulations, 1 study 101 was deemed to have a high risk of bias because of overlap in subgroup definitions, and 1 study 48 was assessed as having an unclear risk of bias because of a lack of definitions for subpopulations. Studies that did not identify any subgroups (n = 19) did not have this criterion applied (eTable 3 in the Supplement).…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Studies that did not identify any subgroups (n = 19) did not have this criterion applied (eTable 3 in the Supplement). 15,37,[55][56][57]63,65,66,69,77,78,81,82,93,102,111,113,114,121…”

Section: Risk Of Biasmentioning

confidence: 99%

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Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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IMPORTANCE Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. OBJECTIVE To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. DATA SOURCES This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. STUDY SELECTION Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years.DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. RESULTS A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, −0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051), income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020,

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

“…Studies that did not identify any subgroups (n = 19) did not have this criterion applied (eTable 3 in the Supplement). 15,37,[55][56][57]63,65,66,69,77,78,81,82,93,102,111,113,114,121…”

Section: Risk Of Biasmentioning

confidence: 99%

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Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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Bacteria producing antimicrobials against Clostridium difficile isolated from human stool

et al. 2020

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Diagnosis and management of paediatric Clostridioides difficile infection in a tertiary centre: A prospective audit

Gates

Best

Roberts

et al. 2020

J Paediatrics Child Health

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Aim The optimisation of diagnosis and management of paediatric Clostridioides (formerly Clostridium) difficile (C. difficile) infection (CDI) has importance on multiple levels, from individual patient to population disease management and infection control. This study aimed to evaluate current practice at a paediatric tertiary hospital against Australasian Society for Infectious Diseases 2016 guidelines. Methods Prospective audit was undertaken. All positive C. difficile tests (by two step immunoassay then polymerase chain reaction) over 6 month period were reviewed for appropriateness of testing, including review of clinical characteristics and treatment of appropriately requested positive tests (CDI cases). Consecutive test requests for C. difficile over 2 month period were reviewed for appropriateness of testing. Results Of 70 consecutive test requests, 64 met laboratory criteria for processing. Of these, 31 (48%) out of 64 were asymptomatic or had clinically insignificant or laxative‐associated diarrhoea. Overall, 44 (63%) out of 70 were deemed inappropriate requests. Of 45 positive tests, 17 (38%) were appropriately requested. Amongst inappropriate requests, 13 (46%) out of 28 were treated; those aged >2 years were significantly more likely to be treated (P < 0.05). Thirteen children were treated unnecessarily. Only one out of seven positive tests in infants (<1 year) was appropriately requested. Haematology/oncology patients accounted for 41% of cases. Treatment was in accordance with guidelines in 58% of cases. Conclusions Inappropriate testing for C. difficile and variable clinical response to positive tests have sequelae including unnecessary antibiotics for hospitalised children. Areas for improvement have been identified and this study confirms the need for establishment of national paediatric CDI guidelines with increased awareness of these by clinicians.

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Clostridioides (Clostridium) difficile carriage in asymptomatic children since 2010: a narrative review

Abstract: View related articles View Crossmark data Citing articles: 1 View citing articles Clostridioides (Clostridium) difficile carriage in asymptomatic children since 2010: a narrative review

Cited by 3 publications

References 48 publications

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Bacteria producing antimicrobials against Clostridium difficile isolated from human stool

Diagnosis and management of paediatric Clostridioides difficile infection in a tertiary centre: A prospective audit

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