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Clostridial infection in children
1Department of Pediatrics, Georgetown University School of Medicine, Washington, DC.
Insights
Clostridium species are significant causes of pediatric infections, frequently isolated from abscesses and other serious conditions. These bacteria often occur in mixed infections, highlighting the need for comprehensive anaerobic microbiology in children.
Area of Science:
- Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Clostridium species are anaerobic bacteria with diverse pathogenic potential.
- Understanding their role in pediatric infections is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To survey the prevalence and types of Clostridium species isolated from pediatric specimens.
- To identify common infection sites and associated predisposing conditions.
- To analyze co-infections involving Clostridium species in children.
Main Methods:
- Retrospective analysis of 1543 specimens submitted to anaerobic microbiology laboratories.
- Identification and quantification of Clostridium species isolates.
- Correlation of isolates with clinical data, infection sites, and co-pathogens.
Main Results:
- Clostridium species were isolated from 7.0% of pediatric specimens (107/1543), with 96 children affected.
- Clostridium perfringens and unidentified Clostridium species were most common.
- Abscesses, peritonitis, and bacteremia were frequent sources, often associated with underlying conditions like immunodeficiency and malignancy.
- Mixed infections were common, with anaerobic cocci, Bacteroides spp., and Escherichia coli frequently isolated alongside Clostridium species.
Conclusions:
- Clostridium species play a significant role in pediatric infections, particularly in serious conditions like abscesses and peritonitis.
- The presence of predisposing factors increases the risk of Clostridium-associated infections in children.
- Comprehensive anaerobic culture and identification are essential for managing polymicrobial infections in pediatric patients.
Abstract:
A survey of the isolation of Clostridium spp. from 1543 specimens sent to anaerobic microbiology laboratories revealed 113 isolates from 107 specimens (7.0% of all specimens) from 96 children. The isolates comprised 43 (38%) unidentified Clostridium spp., 37 (33%) C. perfringens, 13 (12%) C. ramosum, five (4%) C. innocuum, six (5%) C. botulinum, three (3%) C. difficile, two (2%) C. butyricum, and one isolate each of C. bifermentans, C. clostridiiforme, C. limosum and C. paraputrificum. Most clostridial isolates were from abscesses (38), peritonitis (26), bacteraemia (10), and chronic otitis media (7). Predisposing or underlying conditions were present in 31 (32%) cases. These were immunodeficiency (12), malignancy (9), diabetes (7), trauma (7), presence of a foreign body (6) and previous surgery (6). The clostridia were the only bacterial isolates in 14 (15%) cases; 82 (85%) cases had mixed infection. The species most commonly isolated with clostridia were anaerobic cocci (57); Bacteroides spp. (B. fragilis group) (50), Escherichia coli (22), pigmented Prevotella or Porphyromonas spp. (18) and Fusobacterium spp. (10). Most Bacteroides and Escherichia coli isolates with clostridia were from abdominal infections and skin and soft tissue infections adjacent to the rectal area; most pigmented Prevotella and Porphyromonas isolates were from oropharyngeal, pulmonary, and head and neck sites. Antimicrobial therapy was given to all patients, in conjunction with surgical drainage in 34 (35%). Only two patients died. These data illustrate the importance of Clostridium spp. in paediatric infections.