Pediatric Clostridioides difficile Infection: Diagnosis and Diagnostic Stewardship

Abstract

Although the pathogenesis of Clostridioides difficile infection (CDI) is complex and incompletely understood, it is believed that the elaboration of C. difficile toxins is necessary for disease. There are a variety of tests available for the detection of both the C. difficile organism and its toxins; however, each has limitations and the best application of these tests to the diagnosis of CDI in children remains uncertain. Nucleic acid amplification tests are unable to reliably discriminate between CDI and C. difficile colonization, while commercially available enzyme immunoassays for toxin detection lack sensitivity. An understanding of preanalytic factors, relevant patient features, and test performance characteristics is essential to the accurate diagnosis of CDI in children. Specific diagnostic stewardship strategies can also increase the likelihood that positive tests reflect disease rather than colonization. Ultimately, CDI remains a clinical diagnosis and clinical judgment is essential when interpreting test results, regardless of the methods used.

Clostridioides difficile Infections among Pediatric Patients Hospitalized at an Oncology Department of a Tertiary Hospital in Poland

“…Only one patient from the group with a confirmed CDI infection in the last 3 months was not administered an antibiotic, whereas the entire group was subjected to treatment directed against CD. It should be noted that in the case of colonized patients, treatment for CD was administered to as many as 3 4 patients. Only in three children was it decided to stop the administration of antibiotics and postpone chemotherapy, which, according to the information in the medical history, had positive outcomes in the form of the end of gastrointestinal aliments.…”

“…Pediatric patients treated at oncology units are a group of patients at an especially high risk of a Clostridioides difficile infection (CDI) [ 2 ]. On the one hand, one has to remember the high level of CD colonization in children up to 2 years of age and the need to exclude other infectious and non-infectious factors before the final diagnosis [ 3 ]. On the other hand, oncological treatment is related to a high risk of complications, extended hospitalizations, the use of aggressive treatments impacting the entire immune system, and thus a significant probability of infections that require the introduction of protracted antibiotic therapy [ 4 ].…”

Use of PCR Cycle Threshold and Clinical Interventions to Aid in the Management of Pediatric Clostridioides difficile Patients

“…However, they only detect the presence of genes encoding the C. difficile toxins, they lack enough specificity to rule in CDI, and are unable to differentiate between symptomatic infection and colonization [ 2 , 5 ]. There is a very limited number of C. difficile studies involving pediatric patients [ 3 , 7 ]. Furthermore, many of the studies are limited by the lack or inappropriate use of reference diagnostic methods, lack of knowledge about the prevalence of CDI in the studied population, and lack of clinical assessment and/or clinical intervention as part of the study [ 3 ].…”