Determining Incidence Rates of C diff and Recurrence in the Pediatric Population

Although there has been an enormous amount of studies and data in understanding and treating C diff (CDI) presenting in adults, a paucity of data exists in the pediatric population.

As such, a group of Canadian investigators wanted to understand this infection in younger patients.

The investigators led by Nisha Thampi, MD, medical director of the Infection Prevention and Control Program, Children’s Hospital of Eastern Ontario, used a national surveillance platform to perform an extensive review looking at the epidemiological and molecular characteristics of healthcare associated- and community acquired- C diff among children in both inpatient and outpatient settings from 2015 to 2020 in Canada, including recurrent CDI infections.

The results of the study were published in the Journal of The Pediatric Infectious Diseases Society.

“Between 2015 and 2020, findings suggest incidence rates of inpatient HA- and CA-CDI in pediatric and mixed hospitals continue to decline or remain stable,” the authors wrote.

During this period, 1498 primary pediatric CDI cases were diagnosed from 8 to 9 pediatric standalone hospitals and 21–26 mixed hospital settings.

The results demonstrated an overwhelming majority of inpatients diagnosed with HAI-CDI. “Two out of the three cases were considered to be healthcare-associated,” Thampi said in an interview with Contagion. 

“Both pediatric and mixed hospital inpatient CA-CDI rates significantly decreased by 33.3% (p = 0.0388) and 67.1% (p = 0.0146), respectively,” Thampi, and her coauthors wrote.

Thampi and coinvestigators also found the majority of these patients were much younger. “More than half the cases were under the age of 12 years,” Thampi stated.

Although community acquired cases declined since the beginning of the study period (2015); in 2019-2020, there were increases in pediatric (13%) and mixed hospital rates (38%). Obviously this is something to keep careful obervation of in future studies.

CDI Recurrence
Patel and coinvestigators noted primary CDI cases identified between March 1 and April 30 each year and they followed them for up to 8 weeks to determine if CDI recurrence occurred among participating hospitals. Overall, 179 HA-CDI cases and 77 CA-CDI cases were determined to be recurrence.

In a smaller subset of patients the investigators followed, recurrence occurred in 27 of 346 pediatric CDI cases(7.8%). In this CDI population, investigators only had data for 22 patients.

“Seven cases were treated with oral vancomycin only, nine with metronidazole only (seven oral, two parenteral), and two with both metronidazole and vancomycin,” they wrote. “Most recurrent cases followed treatment with oral metronidazole for their primary CDI episode (86.4%, n = 19/22), and no ICU admissions or deaths were reported.”

Contagion spoke to Thampi who addressed more specifics of the study and treatment protocols for this population.