1360. Diagnosis and Management of Clostridium difficile Infection by Pediatric Infectious Diseases Physicians
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Sammons ID Week_sized.pdf (518.6 kB)
  • Background: The incidence of C. difficile infection (CDI) has risen among children; however, optimal management of CDI within a diverse pediatric population remains unclear. Although adult guidelines recommend oral vancomycin for treatment of second recurrence or severe CDI, dedicated pediatric data to support pediatric specific management guidelines are lacking. Our objective was to describe current CDI management practices by pediatric infectious diseases (ID) physicians.

    Methods: We surveyed pediatric members of the Emerging Infections Network, a network of ID physicians across North America, in October 2012. Clinical vignettes were used to determine how physicians modify CDI management based on clinical presentation, such as recurrent or severe CDI, or presence of underlying co-morbidities, including organ transplant, inflammatory bowel disease, and neutropenia.

    Results: Of the 285 physicians surveyed, 167 (59%) responded. There were no significant differences in geography, level of experience, or hospital type between respondents and non-respondents. All respondents (100%) used oral metronidazole for the initial occurrence of mild CDI in a normal host. Management varied substantially for mild CDI in patients with a variety of underlying co-morbidities or immunosuppression, in whom metronidazole therapy was recommended less frequently (41-79%). For management of severe CDI, 65% of respondents preferred oral vancomycin either alone or in combination with at least one other agent; however, over 30% used metronidazole alone. Oral vancomycin alone or in combination was preferred by 92% for management of a second recurrence. Among 125 respondents who reported the use of alternative therapies for recurrent or severe CDI, 23 (18%) recommend fecal microbiota transplant, most commonly for treatment of a third or later recurrence, while 20 (16%) reported ever using fidaxomicin.

    Conclusion: Pediatric ID physicians prefer metronidazole for the treatment of mild CDI in healthy children, but management strategies vary for patients with underlying co-morbidities or recurrent or severe disease. These findings highlight the need for pediatric comparative effectiveness studies aimed at determining the optimal treatment for children with CDI.

    Julia Shaklee Sammons, MD, MSCE1, Jeffrey S. Gerber, MD, PhD2, Pranita D. Tamma, MD, MHS3, Thomas J. Sandora, MD, MPH4, Ritu Banerjee, MD, PhD5, Susan E. Beekmann, RN, MPH6, Philip M. Polgreen, MD6 and Adam L. Hersh, MD, PhD7, (1)Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, (3)Department of Pediatrics, Division of Infectious Diseases, The Johns Hopkins Medical Institution, Baltimore, MD, (4)Division of Infectious Diseases, Department of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, MA, (5)Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, (6)Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (7)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT

    Disclosures:

    J. S. Sammons, None

    J. S. Gerber, None

    P. D. Tamma, None

    T. J. Sandora, None

    R. Banerjee, None

    S. E. Beekmann, None

    P. M. Polgreen, None

    A. L. Hersh, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.