We don't look for C. diff much in kids because kids don't get c. diff disease very often. In fact, simply having C. difficile is more often a sign of carrier status than of active disease. When we diagnosed a little girl on my service with c. diff, I thought I would see what I can learn. There is not much on pediatric C. difficile. I found the following:
McFarland, LV. “Pediatric Clostridium difficile: A Phantom Menace or Clinical Reality?.” Journal of pediatric gastroenterology and nutrition, v. 31 issue 3, 2000, p. 220.
High Points:
In the article, McFarland points out a number of pediatric c. difficile outbreaks. She separates positive C. difficile tests into four categories: "1) asymptomatic carriage, 2) acute and protracted diarrhea, 3) colitis (pseudomembranous colitis [PMC], fulminant colitis, toxic megacolon, and non-PMC colitis), and 4) recurrent infections."
Pediatric C. difficile may or may not be antibiotic associated.
High risk antibiotics are clindamycin, amoxicillin, ampicillin, and 2nd/3rd generation cephalosporins (our patient had had separate courses of two of these in the last month!).
I would add that the spores are not killed by alcohol hand rub, so soap and water is your friend in a C. difficile patient's room.
There was also a reasonably solid review article in the NEJM at the end of October this year.
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1 comment:
Gabe couldn't help but bring up an article that should not go without mentioning in any discussion of C. diff (for the grossout factor alone).
article
Yep, donor stool administered via NG. Of the 18 patients, 15 had resolution, one failed, and two died (one of peritonitis and one of pneumonia). Hopefully the one that died of pneumonia didn't reflux and aspirate her stool transplant.
Of note, donors were fairly heavily screened for infectious things prior to transplant.
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