Clostridioides difficile infection in hospitalized children and adolescents

Edwards et al., in their recent study, examined a 42-hospital Pediatric Health Information System (PHIS) administrative database to revise prior studies on the incidence and circumstances of Clostridioides difficile infections (CDI), use of diagnostic tests, and management of infections. They analyzed >23000 cases of CDI in hospitalized children from 2013 – 2019. Reversing a trend of bygone decades, they discovered a decline in hospitalized cases of CDI over the study period, from 7.09 cases/10000 patient days in 2013 to 4.89 cases/10000 patient days in 2019. They also found a decrease in C difficile-specific testing and an increase in the use of GI panel PCR testing. As earlier, >80% of patients with CDI displayed the presence of an underlying condition, with one-third each with chronic GI conditions or malignancy. Although metronidazole remained the most popular therapy choice, its use fell, contrasting to oral vancomycin.

There might be a true decline in CDI incidence in hospitalized pediatric patients due to improved cleaning and infection control practices and the more judicious use of antibiotics, yet there are many other factors too that could direct only an apparent change, most notably the modifications via guidelines to minimize by pre-test selection to a smaller number of patients being tested, and employing a stepwise testing scheme that would reduce detection of colonized-only individuals. 

More precise observation over the next decade will render detailed data on the inpatient burden of CDI and the effectiveness of the measure we take daily, such as handwashing, cleaning, and control of prescribing unnecessary antibiotics, to reduce the occurrence and spread of cases further.

Long SS. Contemporary observations on clostridioides difficile infection in hospitalized children and adolescents. The Journal of Pediatrics. 2023;252:1-2. DOI:https://doi.org/10.1016/j.jpeds.2022.11.017