Large analysis finds asymptomatic C. difficile most common among infants
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Among asymptomatic children, the prevalence of Clostridioides difficile is greatest among infants aged between 6 and 12 months, according to the results of a systematic review and meta-analysis published in JAMA Pediatrics.
C. difficile was detected in more than 40% of infants aged 6 to 12 months — although the rate of toxigenic C. difficile was much lower — and was far less common among children aged 5 to 18 years. The researchers said the results of the analysis “may provide context for interpreting C. difficile test results among young children.”
The CDC estimates that C. difficile causes more than half a million infections in the United States each year. A 2018 study published in Clinical Infectious Diseases found that the incidence of C. difficile had risen in children since 2000 — mostly among children in community and outpatient settings but also among nonhospitalized children.
Stephen B. Freedman, MDCM, MSc, a professor of pediatrics and emergency medicine at Alberta Children’s Hospital and the University of Calgary Cumming School of Medicine, said in an interview with Healio that the idea for the current study originated in the observation that clinicians are increasingly seeing test results that are positive for C. difficile.
“We wanted to find out how commonly C. difficile is detected and present when not truly pathogenic,” Freedman said.
Freedman and colleagues reviewed 95 studies from around the globe that included more than 19,000 pediatric patients and found that rates of detection of toxigenic or nontoxigenic C. difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years.
The prevalence of toxigenic C. difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years.
Freedman said the findings speak to the importance of considering C. difficile test results in context.
“If you just react to the test result, you're going to be treating a large number of children as if they have C. difficile infection when they in fact do not, and that usually leads to the overuse of broad-spectrum antibiotics,” Freedman said.
In the meantime, Freedman said, providers and parents should be cognizant of the perils of ineffective testing.
“I think it's important ... to understand that detection of C. difficile itself does not equate with infection,” Freedman said. “[It is also important to clarify] ... whether treatment is indicated for an infection. The vast majority of tests are less likely to indicate true infection in children.”
References:
CDC. C. diff (Clostridioides difficile). https://www.cdc.gov/cdiff/index.html. Accessed August 27, 2021.
McDonald, LC, et. al, Clin Infect Dis. 2018;doi:10.1093/cid/cix1085.
Tougas SR, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.2328.