Methods: This was a retrospective cohort study for patients aged 1-21 years treated for CDI at our institution from January 2010 – December 2014
Results: We identified 201 patients, accounting for 231 separate episodes of CDI. Fourteen percent of those with CDI had known or were found to have IBD. Roughly 36% of patients were immunocompromised, and 49% had recent antibiotic exposure. Ten to 14 days of oral metronidazole was the most common initial treatment (70%) followed by vancomycin monotherapy (15%) and combination therapy (12%). About 28% of cases had at least one documented recurrence. For initial treatment of CDI, 78% of those treated with vancomycin monotherapy relapsed, whereas only 18% of those treated with metronidazole had recurrent CDI. Patients that had a first recurrence were treated equally with vancomycin or metronidazole (27/58), and the majority of second occurrences were treated with metronidazole. FMT, though only used in 5% of cases, had an 83% success rate.
Conclusion: Our results reflect a lower recurrence rate (28%) compared to the existing pediatric literature (35%). Recent antibiotic use, though thought to be a major trigger for the majority of CDI, was a risk factor in less than half of cases; our data suggest that immunosuppression plays a role in host susceptibility to CDI. Metronidazole had a high success rate as a first line agent. Though currently reserved for multiple resistant cases, FMT is highly successful and can be considered earlier in the clinical course as a definitive treatment option for children with recurrent CDI.
R. Olivero, None