Clostridium diffi cile infection in children: characteristics and treatment – a single-center study from Romania

The incidence of Clostridium diffi cile infection (CDI) in children is progressively increasing. The study evaluated the characteristicsand antibacterial treatment of CDI at a Romanian pediatric gastroenterology department. We performed a retrospective study toanalyze cases diagnosed with CDI, identifi ed through immunoassays for Clostridium diffi cile toxins in stools, between January 1,2005 and December 31, 2015. Eighty-nine episodes of CDI were diagnosed in 73 patients. We noticed an increasing incidence reachingmaximum in 2014 with 6.9 cases/1000 patients. Almost 40% of patients had community-acquired CDI. The most frequentlyassociated comorbidities were infl ammatory bowel disease and cow’s milk allergy. There was a small percentage of recurrent episodes(24.2%). Metronidazole was administered as fi rst-line treatment in 49.2% of mild/moderate cases and proved eff ective in 79.4%of these. More than 70% of all patients in which metronidazole was not effi cient had comorbidities, compared to 22.2% of patientswhere metronidazole was effi cacious. The alternative was vancomycin which cured the disease in all cases. In severe forms, a combinationof intravenous metronidazole and oral vancomycin was the effi cient solution. Oral vancomycin was the effi cacious treatmentfor the fi rst recurrence. We report an increasing incidence of CDI in Romanian children. The failure rate for metronidazoletreatment was low, thus metronidazole may be safely recommended for the fi rst episode of mild/moderate CDI. Vancomycin provedeff ective in all cases, regardless of the fi rst episode or recurrence, and may be used effi ciently as fi rst-line treatment.Key words: Clostridium diffi cile; antibacterial treatment; children

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