Clostridium Difficile Infection in Children: a Review.

Clostridium difficile is a sporogenic, anaerobic, Gram-positive, emerging enteric pathogen. It represents the most common cause of healthcare-associated diarrhoea in the United States, with significantly associated morbidity, mortality and healthcare costs. Historically regarded as a little more than an innocent colonizer bystander of the gastrointestinal tract of children, Clostridium difficile has increasingly demonstrated its behavior as a true pathogen in the paediatric age groups. This organism may be responsible for a broad spectrum of diseases in children, ranging from self-limiting secretory diarrhoea to life-threatening conditions, such as pseudomembranous colitis, toxic megacolon, intestinal perforation and septic shock. However, the incidence and severity of Clostridium difficile infection are not completely understood in this population. In particular, while asymptomatic carriage remains high among infants, the clinical significance of detecting Clostridium difficile in children aged 1 to 3 years is not fully understood. Moreover, recent epidemiological surveillance has demonstrated a rise in the incidence of Clostridium difficile infection, particularly in the community and in low-risk settings. Interestingly, such cases may not show the disease pattern to be associated with typical risk factors, such as recent exposure to antimicrobial drugs or on-going contacts with the healthcare system. The purpose of this review is to present the features of Clostridium difficile infection that are unique to paediatric patients and to update paediatricians on information and recommendations regarding Clostridium difficile infection in children. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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