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Baseline stool toxin concentration is associated with risk of recurrence in children with Clostridioides difficile

Thomas J Sandora1,2, Larry K Kociolek3,4, David N Williams5

  • 1Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.

Infection Control and Hospital Epidemiology
|January 10, 2023
PubMed

Insights

Higher stool toxin levels in children with Clostridioides difficile infection (CDI) predict recurrence. Toxin quantification may aid in assessing CDI severity and predicting outcomes in pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Gastroenterology
  • Microbiology

Background:

  • Clostridioides difficile infection (CDI) poses significant risks in adults, with toxin levels linked to disease severity and recurrence.
  • Evaluating toxin concentration as a predictive marker in pediatric CDI is crucial for understanding disease progression.

Purpose of the Study:

  • To investigate the association between baseline stool toxin A and B concentrations and severe outcomes or recurrence in children with CDI.
  • To assess the predictive value of toxin levels for CDI severity and clinical outcomes in pediatric patients.

Main Methods:

  • A prospective cohort study involving 187 pediatric inpatients (aged 2-17 years) diagnosed with CDI.
  • Measurement of baseline stool toxin A and B concentrations using ultrasensitive single-molecule array assay.
  • Follow-up for 40 days to assess severe outcomes and recurrence, with plasma cytokine analysis in available samples.

Main Results:

  • No significant difference in toxin levels between severe and non-severe baseline disease, or between severe outcomes and no severe outcomes.
  • A significant association was found between higher baseline stool toxin A+B concentration and CDI recurrence (P = .024).
  • Elevated plasma granulocyte colony-stimulating factor was observed in CDI patients compared to controls (P < .001).

Conclusions:

  • Higher baseline stool toxin concentrations are a significant predictor of CDI recurrence in children.
  • Toxin quantification warrants inclusion in pediatric CDI treatment trials for severity assessment and outcome prediction.
Abstract

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