Clinical and Microbiologic Assessment of Cases of Pediatric Community-associated Clostridium difficile Infection Reveals Opportunities for Improved Testing Decisions. Issue 2 (February 2016)

• Record Type: Journal Article
• Authors: Kociolek, Larry K.; Patel, Sameer J.; Zheng, Xiaotian; Todd, Kathleen M.; Shulman, Stanford T.; Gerding, Dale N.
• Is Part Of: Pediatric infectious disease journal. Volume 35:Issue 2(2016)
• Publication Date: 2016-02
• Subjects: Clostridium difficile -- pediatric -- community-associated -- testing; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000954
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Most children with Clostridium difficile infection (CDI) experience community onset of CDI symptoms. Methods: We retrospectively compared hospital-onset healthcare facility–associated CDI cases to community-associated (CA) CDI cases diagnosed by Cepheid Xpert tcdB polymerase chain reaction (PCR) at an academic children's hospital over a 1-year period. Saved stools from CDI cases additionally underwent anaerobic stool culture and multiplex gastrointestinal pathogen PCR testing. Results: Compared with 25 hospital-onset healthcare facility–associated CDI cases, the 74 CA-CDI cases were more frequently <2 years old (18% vs. 0%, P = 0.034) and less frequently had antibiotic exposure in the past 30 days (26% vs. 88%, P < 0.0001), proton pump inhibitor exposure (16% vs. 36%, P = 0.036) or a gastrostomy tube (11% vs. 32%, P = 0.013). Among children diagnosed with CA-CDI, 19 (26%) had no identified CDI risk factors (immunocompromised; gastrostomy tube; recent antibiotic, proton pump inhibitor or inpatient/outpatient healthcare exposures). Clinical testing for viral pathogens was uncommon among children thought to have CA-CDI. Multiplex PCR testing of saved stool samples failed to identify C. difficile among 23% of cases diagnosed with CA-CDI by the Cepheid Xpert tcdB PCR assay. CDI antibiotic therapy was provided to nearly all patients testing positive by tcdB PCR irrespective of CDI risk factors. Conclusions: Many children diagnosed with CA-CDI by PCR lack CDI risk factors and have discordant results when additional CDI testing methods are performed, suggesting overdiagnosis of CDI in children with community-onset diarrhea. More selective CDI testing of low-risk pediatric patients is needed to more accurately diagnose CDI and limit unnecessary CDI antibiotic treatment in children. Abstract : Supplemental Digital Content is available in the text.