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Eur J Clin Microbiol Infect Dis. 2017 Jan;36(1):177-185. doi: 10.1007/s10096-016-2793-7. Epub 2016 Sep 30.

Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.

Author information

1
Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy. andrea.lovecchio@unina.it.
2
Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy.
3
Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy.
4
Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy.
5
Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy.
6
Hospital of Ravenna, Via Vincenzo Randi 5, Ravenna, Italy.
7
Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.

Abstract

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.

PMID:
27696233
DOI:
10.1007/s10096-016-2793-7
[Indexed for MEDLINE]

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