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Clostridium difficile causing pediatric infections: New findings from a hospital-based study in Italy
Patrizia Spigaglia1, Fabrizio Barbanti1, Elio Castagnola2
1Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
Insights
Clostridium difficile infections (CDIs) are changing in children. This study found common strains and antibiotic resistance in pediatric CDI cases, highlighting the need for better diagnosis and antibiotic control.
Area of Science:
- Infectious Diseases
- Microbiology
- Pediatrics
Background:
- Epidemiology of Clostridium difficile infections (CDIs) in pediatric patients is not well understood.
- Limited data exists on C. difficile strains and antibiotic susceptibility in children.
- Recent studies suggest a shift in CDI epidemiology among pediatric populations.
Purpose of the Study:
- To investigate the epidemiology of CDI in a large Italian pediatric hospital.
- To analyze C. difficile isolates for prevalent PCR-ribotypes (RTs), binary toxin (CDT)-positive strains, and antibiotic susceptibility.
- To identify emerging C. difficile strains and resistance patterns in children.
Main Methods:
- Retrospective analysis of CDI cases in a pediatric hospital.
- Identification of C. difficile isolates using PCR-ribotyping.
- Detection of binary toxin (CDT) production.
- Antibiotic susceptibility testing of C. difficile isolates.
Main Results:
- CDI incidence was 6.6 cases/1000 admissions, with 92% being healthcare-associated.
- Predominant strains were RT020 (16%) and RT014 (14%); RT356/607 and RT018 were rare.
- 20% of isolates were CDT-positive, including emerging RT033 and RT442.
- Nearly 50% of toxigenic isolates showed antibiotic resistance, with 20% being multidrug-resistant (MDR).
Conclusions:
- Specific C. difficile strains and MDR patterns are emerging in pediatric populations.
- Healthcare-associated CDI is common, particularly in Hematology-Oncology and Gastroenterology units.
- Rapid CDI diagnosis, pediatric C. difficile monitoring, and stricter antibiotic control are crucial in Italian pediatric hospitals.
Abstract:
Recent studies support a change of Clostridium difficile infections (CDIs) epidemiology in pediatric patients. Since limited information is available about C. difficile in this population, we investigated the epidemiology of CDI in a large pediatric hospital that acts as reference centre in Italy and analyzed C. difficile isolates to identify the prevalent PCR-ribotypes (RTs), the binary toxin (CDT)-positive strains and the antibiotic susceptibility patterns. The CDI incidence was 6.6 cases/1000 admissions and the majority (92%) of CDI were healthcare-associated (47% occurred in the Hematology-Oncology and in the Gastroenterology units). Most of symptomatic children <3 years with a positive culture for C. difficile were negative for other gastrointestinal pathogens, supporting C. difficile as cause of disease in these patients, including those showing recurrences. Strains RT020 (16%) and RT014 (14%) were identified as the main cause of infection, while RT356/607 and RT018, predominant in Italian adult patients, were absent (RT356/607) or rarely found (RT018) among children. CDT-positive strains represented the 20% of the total number of isolates analyzed. In particular, two emerging types, RT033 and RT442, were recognized as Toxin A-/Toxin B-/CDT+. Resistance to antibiotics characterized almost 50% of the toxigenic isolates analyzed in this study and, in particular, 20% of them were multidrug resistant (MDR). The emergence and circulation of strains with peculiar toxins profiles and/or MDR strongly highlight the necessity of a rapid CDI diagnosis, a careful monitoring of C. difficile in pediatric patients and a more strict control of antibiotics usage in the Italian pediatric hospitals.
