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Diagnosis and management of paediatric Clostridioides difficile infection in a tertiary centre: A prospective audit
Victoria Gates1, Emma Best1,2, Sally Roberts3
1Department of Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand.
Insights
Many pediatric Clostridioides difficile infection tests are inappropriate, leading to unnecessary treatments. Guidelines are needed to improve diagnosis and management of this infection in children.
Area of Science:
- Infectious Diseases
- Pediatric Healthcare
- Clinical Microbiology
Background:
- Optimizing diagnosis and management of Clostridioides difficile infection (CDI) in children is crucial for patient outcomes and infection control.
- Current practices in pediatric CDI diagnosis and treatment require evaluation against established guidelines.
Purpose of the Study:
- To assess the appropriateness of current Clostridioides difficile testing and treatment practices in a pediatric tertiary hospital.
- To compare hospital practices against the Australasian Society for Infectious Diseases 2016 guidelines for CDI.
Main Methods:
- A prospective audit of C. difficile test requests and positive results over a defined period.
- Review of clinical characteristics, appropriateness of testing, and treatment protocols for CDI cases.
- Analysis of test requests for C. difficile over a two-month period to assess testing appropriateness.
Main Results:
- A significant proportion of C. difficile tests (63%) were deemed inappropriate, with many positive tests (38%) originating from inappropriate requests.
- Unnecessary treatment occurred in 13 children, with older children (>2 years) more likely to receive treatment even when tests were inappropriate.
- Haematology/oncology patients represented a substantial portion (41%) of CDI cases, and treatment adherence to guidelines was suboptimal (58%).
Conclusions:
- Inappropriate C. difficile testing and inconsistent clinical management lead to adverse outcomes, including unnecessary antibiotic use in hospitalized children.
- The study highlights the need for improved clinician awareness and the establishment of national pediatric CDI guidelines.
- Enhancing diagnostic stewardship and adherence to evidence-based guidelines are critical for optimizing pediatric CDI care.
Aim:
The optimisation of diagnosis and management of paediatric Clostridioides (formerly Clostridium) difficile (C. difficile) infection (CDI) has importance on multiple levels, from individual patient to population disease management and infection control. This study aimed to evaluate current practice at a paediatric tertiary hospital against Australasian Society for Infectious Diseases 2016 guidelines.
Methods:
Prospective audit was undertaken. All positive C. difficile tests (by two step immunoassay then polymerase chain reaction) over 6 month period were reviewed for appropriateness of testing, including review of clinical characteristics and treatment of appropriately requested positive tests (CDI cases). Consecutive test requests for C. difficile over 2 month period were reviewed for appropriateness of testing.
Results:
Of 70 consecutive test requests, 64 met laboratory criteria for processing. Of these, 31 (48%) out of 64 were asymptomatic or had clinically insignificant or laxative-associated diarrhoea. Overall, 44 (63%) out of 70 were deemed inappropriate requests. Of 45 positive tests, 17 (38%) were appropriately requested. Amongst inappropriate requests, 13 (46%) out of 28 were treated; those aged >2 years were significantly more likely to be treated (P < 0.05). Thirteen children were treated unnecessarily. Only one out of seven positive tests in infants (<1 year) was appropriately requested. Haematology/oncology patients accounted for 41% of cases. Treatment was in accordance with guidelines in 58% of cases.
Conclusions:
Inappropriate testing for C. difficile and variable clinical response to positive tests have sequelae including unnecessary antibiotics for hospitalised children. Areas for improvement have been identified and this study confirms the need for establishment of national paediatric CDI guidelines with increased awareness of these by clinicians.
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