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Investigation and management of Clostridium difficile colonisation in a paediatric oncology unit
1Department of Paediatric Oncology, St Bartholomew's Hospital, London.
Insights
Clostridium difficile infection (CDI) in pediatric cancer patients is a concern. This study found infection determinants were hospital stay and diagnosis, not age, with lymphoid malignancies at highest risk.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Limited data exists on Clostridium difficile infection (CDI) in pediatric cancer patients.
- Previous reports suggested a high carriage rate and morbidity, particularly in younger children.
- A presumed outbreak prompted further investigation into CDI prevalence in this vulnerable population.
Purpose of the Study:
- To monitor the prevalence of Clostridium difficile infection on a pediatric oncology ward.
- To identify risk factors and determinants for CDI in children undergoing cancer treatment.
- To investigate the origin and characteristics of CDI during the study period.
Main Methods:
- Prospective surveillance of CDI in 214 children on a pediatric oncology ward from June 1991 to May 1992.
- Polyacrylamide gel electrophoresis (PAGE) used to characterize C. difficile strains.
- Analysis of patient data to determine factors associated with infection, including age, diagnosis, treatment intensity, neutropenia, and antibiotic exposure.
Main Results:
- Twenty-eight (13%) of 214 children were infected with C. difficile.
- Strain typing revealed multiple C. difficile types, suggesting endogenous or environmental origins rather than cross-infection.
- Infection was not associated with age; however, duration of hospital stay and primary diagnosis (lymphoid malignancies highest risk) were significant determinants. Intensive treatment, neutropenia, and prolonged antibiotic use were associated with highest risk.
Conclusions:
- CDI in pediatric oncology patients is influenced by treatment intensity and duration of hospital stay, not age.
- Lymphoid malignancies and intensive treatment protocols requiring prolonged neutropenia and antibiotics confer the highest risk.
- Prompt identification and control measures are crucial; diarrhea in these patients should always be investigated.
Abstract:
Little is known about Clostridium difficile infection in children with cancer but a presumed outbreak has previously been described. The carriage rate before admission to hospital and morbidity is reported to be high, especially in younger children. The prevalence of C difficile infection on a paediatric oncology ward was monitored from June 1991 to May 1992. Twenty eight (13%) of 214 children were found to be infected. Though the temporal distribution suggested an outbreak, polyacrylamide gel electrophoresis identified several different types. Unlike previous reports, infection appeared to be possibly endogenous or possibly environmental in origin rather than due to cross infection; the morbidity was low and age was not a determinant for infection. The duration of hospital stay and the primary diagnosis were found to be determinants for infections, those with lymphoid malignancies being at the highest risk. The diagnostic category at greatest risk were those most intensively treated, with protracted neutropenia and prolonged antibiotic exposure. Early identification of cases and prompt institution of simple control measures will prevent cross infection. It is therefore important that diarrhoea is not accepted as a normal symptom of cancer chemotherapy and stool specimens are sent for full bacteriological and viral investigation.