Recent advances in Clostridioides difficile infection epidemiology, diagnosis and treatment in children

Abstract

Purpose of review The US Centers for Disease Control and Prevention (CDC) classified Clostridioides difficile as an ‘urgent’ public health threat that requires ‘urgent and aggressive action’. This call to action has led to new discoveries that have advanced C. difficile infection (CDI) epidemiology, diagnosis and treatment, albeit predominantly in adults. In 2017, the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America published clinical practice guidelines for both adults and children. At that time, recommendations in children were generally limited to relatively low-quality evidence. Recent findings Since publication of this guidance, there have been many advancements in the understanding of CDI in children. These include better understanding of healthcare settings as uncommon sources of C. difficile acquisition in children; risk factors for recurrent and community-associated CDI; performance of diagnostic tests in children and strategies for optimizing their use; and a more rigorous evidence base for CDI treatment in children, including the first-ever randomized controlled trial of CDI treatment in children and the largest study of fecal microbiota transplantation in children. Summary This review highlights the most recent salient advancements in paediatric CDI knowledge and practice that supplement published clinical guidance provided prior to these advancements.

Clostridioides difficile detection and infection in children: are they just small adults?

“…As such methods rely on the amplification of specific DNA targets, they often have improved sensitivity compared to EIA tests. They however do not determine active toxin production or viability and, as such, are not appropriate in isolation for differentiating C. difficile infection from colonization [40]. It has also been suggested that the improved sensitivity of one-step molecular assay workflows may contribute to overdiagnosis of CDI in paediatric patients, subsequently leading to unnecessary antibiotic use [41].…”

How to: Clostridioides difficile infection in children

“…Malignancy and multiple antibiotic treatments were identified as risk factors for severe CDI in a study of 82 patients [53,54].…”

Children gut microbiota exhibits a different composition and metabolic profile after in vitro exposure to Clostridioides difficile and increases its sporulation

“…In addition, young children are often colonized by toxigenic strains while remaining asymptomatic (Collignon et al, 1993;Jangi and Lamont, 2010;Adlerberth et al, 2014). Therefore, children have long been considered to be at low risk for symptomatic CDI but the epidemiology of CDI in children has changed over the past decade (Kociolek et al, 2021). Similar to adult infections, severe cases, hypervirulent strains, more community-onset infections without previous antibiotic exposure, and outbreaks have been observed in pediatric populations (Noor and Krilov, 2018;Kociolek et al, 2021).…”