Many recent reports have provided conflicting data with regard to Clostridium difficile infection (CDI) epidemiology. Some of the newest data needs to be interpreted with caution due to the adoption of PCR technology. Previously, CDI was difficult to culture and identify. The problem now is proving causation when C diff is identified.
J Pediatr 2013; 163: 699-705. This study, using an administrative database, analyzed 33,095 first pediatric hospitalizations for malignancy from 43 pediatric hospitals between 1999 and 2011. A total of 1736 admissions with CDI were identified; 380 were considered hospital-acquired. The authors noted an apparent decrease in CDI incidence between 2006-2010. Exposure to chemotherapy, proton pump inhibitors and certain antibiotics were independent risk factors for hospital-acquired CDI.
JPGN 2013; 57: 487-88. New-onset patients with IBD cases were retrospectively reviewed from 2010-2012. 10 cases (8.1%) of 124 were positive for CDI within the first two months of diagnosis. Only 42% of the total 290 new IBD cases had documented testing for CDI. The prevalence of CDI without obvious preceding antibiotic exposure was 2.4%.
JPGN 2013; 57: 293-97. Between 2006-2012, stool samples were prospectively obtained from children with IBD (UC, n=76, Crohn, n=69) and controls with other noninflammatory GI conditions (n=51).
- The prevalence of positive PCR results were 11.6% in patients with Crohn disease, 18.4% in patients with UC, and 11.8% in controls. No significant difference.
- CDI as identified by PCR may be an incidental finding.
- Only test diarrheal stools. Testing for cure is not recommended.
- Asymptomatic colonization with C diff is frequent in patients with and without IBD
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