Clostridium difficile in the paediatric population
Abstract number: O462
Reddy S.N., Kalima P., Collie M.H.S., Anderson D.N., Poxton I.R.
Objectives:Clostridium difficile Associated Disease (CDAD) cases are increasing.
There has been a shift in trends with a rising number of cases being reported in low-risk populations, e.g. children and young peri-partum women. Our aim was to review the prevalence of C. difficile in the in-patient paediatric population presenting to a Children's Hospital within a University Hospitals Trust from 20002006 inclusive, and to further assess the data set for 2006.
Methods: Patients were identified via Medical Microbiology databases. Patients ranging from greater than one-month to less than 14 years were included. Retrospective analysis of prospectively collected outcome data was then performed.
Results: There has been an increase in the number of diagnosed paediatric CDAD cases over the last year. (A detailed breakdown is shown in the table attached).
Further analysis of data for 2006 revealed 603 faecal samples were tested for C. difficile of which 33 samples were positive. Taking into account multiple samples testing for individual patients 22 patients were diagnosed with CDAD out of 335. Of the 22 positive patients there was no significant gender bias (Male:Female=10:12) and the median age was 3 years (range 2 months 13 years). For this cohort 117 samples were analysed ranging from 131 samples per patient over a time period of 1331days. Only 54% of patients were found to be toxin positive on their first sample. A median period of 23days (range 2102 days) was conceded prior to detection of C. difficile toxin, from the time of their first negative sample being assessed to the ultimate positive sample, a median of 3 (range 26) samples was sent prior to detection. 23% of positive patients had CDAD re-diagnosed on subsequent samples following a negative sample. In these cases the median duration was 22 days (range 15104days) following a median of a further 2 samples being analysed (range 24).
Conclusions: The diagnosis of C. difficile is increasing in this previously low-risk paediatric population and therefore is a clinical diagnosis that must be considered early. Culture in conjunction with toxin testing may have led to an earlier diagnosis in nearly 50% of patients and there is a possibility that re-infection/re-colonisation may occur in up to a quarter of Paediatric cases. Mandatory data reporting is only required for patients over 65 years resulting in this important sub-set being excluded.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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