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Published on: December 10, 2016
Clostridium difficile infections in young infants: Case presentations and literature review
Gé-Ann Kuiper1, Joffrey van Prehn2, Wim Ang2
1Department of Pediatrics, Onze Lieve Vrouwe Gasthuis locatie Oost, Amsterdam, The Netherlands.
Insights
Symptomatic Clostridium difficile infections can occur in young infants, challenging current medical practice. This study highlights cases of C. difficile-associated bloody diarrhea in infants, suggesting it should be considered in diagnosis.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Current practice often excludes Clostridium difficile testing in infants under two due to assumed lack of toxin receptors.
- This assumption is based on limited evidence, primarily from small animal studies.
- Clostridium difficile infection (CDI) is a significant cause of antibiotic-associated diarrhea in adults.
Purpose of the Study:
- To investigate the occurrence and clinical presentation of Clostridium difficile infections in neonates and young infants.
- To challenge the existing clinical practice of not testing young children for CDI.
- To review existing literature on CDI in children under two years of age.
Main Methods:
- Presentation of two case studies of infants with recurrent bloody diarrhea post-antimicrobial therapy.
- Diagnostic testing for toxigenic Clostridium difficile in affected infants.
- Comprehensive literature review on Clostridium difficile infections in children under two years.
Main Results:
- Both presented infants showed positive tests for toxigenic Clostridium difficile.
- Infants were successfully treated with metronidazole and vancomycin.
- Literature review supports Clostridium difficile as a potential cause of bloody diarrhea in this age group, especially after antibiotic use.
Conclusions:
- Clostridium difficile infection is a potential cause of bloody diarrhea in neonates and young infants.
- Previous antimicrobial therapy is a significant risk factor for CDI in this population.
- Clinical practice should reconsider the exclusion of CDI testing in infants presenting with relevant symptoms.
Abstract:
It has been assumed that symptomatic Clostridium difficile infections do not occur in young infants, as this specific group would lack specific C. difficile toxin receptors. As a consequence, it is often current practice not to test for C. difficile in neonates and young infants up to 2 years of age presenting with (bloody) diarrhea. The evidence to support this is, however, weak and largely based on small, poorly designed animal studies. We present two young infants with recurrent bloody diarrhea following antimicrobial therapy, positive testing for toxigenic C. difficile and successfully treated with metronidazole and vancomycin, and provide an overview of the literature on C. difficile infections in children under two years of age. Both our case histories and the literature search provide evidence for C. difficile infection as a potential cause of bloody diarrhea in neonates and young infants, in particular after previous treatment with antimicrobials.
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