87. Severe Clostridium difficile Infection in Children
Session: Oral Abstract Session: New Considerations in C. difficile Prevention and Treatment
Thursday, October 3, 2013: 8:54 AM
Room: The Moscone Center: 300
Background:   Clostridium difficile (CD) infection (CDI) is an increasingly important cause of morbidity and mortality in adults.  Traditionally, children have been considered low-risk and to experience only a mild illness.  Recent epidemiologic studies, however, show that the incidence of pediatric CDI is increasing and that severe, life-threatening disease can occur.  We describe the epidemiology, clinical features, and outcome of severe CDI at a tertiary-care children’s hospital.

Methods:   Stool specimens that tested positive for CD by RT-PCR were identified from February 1, 2011 to August 31, 2011.  The medical records of children ≥1 year old with diarrhea and a positive CD test were reviewed; children without diarrhea were excluded.  Severe CDI was defined by the presence of a CDI-related complication or ≥2 clinical features: fever, bloody stools, leukocytosis, hypoalbuminemia, or elevated creatinine.

Results:   88 total patients were identified.  19 children (21.6%) met criteria for severe CDI.  6 children (6.8%) had CDI-related complications – ICU admission at diagnosis (3), pneumatosis intestinalis (1), need for surgical intervention (1), and death (1).  13 children (14.8%) had severe CDI based on the clinical criteria. 

For children with severe CDI, 31.5% had hospital-acquired CDI, 36.8% had community-acquired CDI, and 31.6% had community-onset indeterminate CDI.  89.5% had an underlying medical condition.  The clinical symptoms included fever (94.7%), abdominal pain (42.1%), vomiting (42.1%), and bloody stools (36.8%).  A median of 8 bowel movements/day was experienced at the peak of illness (range 3-18 BMs/day).  Treatment included metronidazole (52.6%), vancomycin (15.8%), or combination therapy (26.3%).  1 patient improved without antibiotic therapy.  The rate of refractory and recurrent disease was 10.5% and 15.8%, respectively.  The all-cause 3-month mortality was 5.3%.  There was 1 death attributable to CDI.

Conclusion:   Severe CDI is frequently encountered among children at our institution.  Complications due to CDI were not uncommon.  A surprising proportion of severe CDI in children was community-acquired, a finding that warrants further investigation.

Jonathan Crews, MD, Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX, Hoonmo L. Koo, MD, Baylor College of Medicine, University of Texas-Houston School of Public Health, Houston, TX, Zhi-Dong Jiang, MD, PhD, The University of Texas Houston School of Public Health, Houston, TX, Jeffrey Starke, MD, FIDSA, Department of Pediatrics, Baylor College of Medicine, Houston, TX and Herbert Dupont, MD, FIDSA, St. Luke's Episcopal Hospital and Kelsey Research Foundation and Kelsey-Seybold Clinic, Houston, TX

Disclosures:

J. Crews, None

H. L. Koo, None

Z. D. Jiang, None

J. Starke, None

H. Dupont, None

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