title: Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.
abstract: Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3 months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8 %) had CA-CDI. Children with HA-CDI (39.2 %) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7 % of cases (87/123) and vancomycin in 29.3 % (36/123), with similar success rates. Recurrence occurred in 16 children (10.8 %), and 3 (2 %) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy. andrea.lovecchio@unina.it.
authors.forename: A
authors.initials: A
authors.lastname: Lo Vecchio
authors.affiliation: Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lancella
authors.affiliation: Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tagliabue
authors.affiliation: Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: De Giacomo
authors.affiliation: Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Garazzino
authors.affiliation: Hospital of Ravenna, Via Vincenzo Randi 5, Ravenna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mainetti
authors.affiliation: Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cursi
authors.affiliation: Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Borali
authors.affiliation: Regina Margherita Children's Hospital, University of Turin, Piazza Polonia 94, Turin, Italy.
authors.forename: M V
authors.initials: MV
authors.lastname: De Vita
authors.affiliation: Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Boccuzzi
authors.affiliation: Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Castellazzi
authors.affiliation: Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Gaetano Pini 3, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Guarino
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin