Greetings from the Southern Hemisphere. I thought I’d try out this discussion board, to get some opinions from North America on pediatric C. difficile policies.
In Australia we have not yet seen “hypervirulent” C. diff, and this organism has traditionally been a low infection control priority in Australian childrens hospitals: We rarely see severe or relapsing disease, and asymptomatic carriage of toxigenic strains in younger children has meant that diagnostic testing is not performed routinely for hospital-onset diarrhoea.
Should we start taking this more seriously, in anticipation of the (probably inevitable) arrival of more pathogenic strains?
Do N. American labs routinely test for C. difficile on diarrhoeal stools from children >48 hours after admission, or when a history of antibiotic use is provided?
What do you do with children who test positive? Do you follow the full SHEA/IDSA recommendations, or some modified version of these?
Have you seen much severe C. difficile disease in children due to the emerging strains in adult/geriatric areas?
Thanks in anticipation of your comments,
David Andresen
Medical Microbiologist
Childrens Hospital at Westmead, Sydney, Australia
Filed under: PSIG
At Kosair Children’s Hospital in Louisville, KY we have seen an increase in C. difficile toxin disease in both inpatients and children being admitted from the community. Some of these kids with community-onset diarrhea have recent hospitalization and some do not.
We do not routinely test for the NAP1 strain, but I have a sense that we are seeing more severe disease and disease in children previously not thought to be at risk. In addition to healthy kids from the community, we have seen a case of confirmed disease in a 10 month old.
We do follow published recommendations for isolation precautions and we have started using a bleach product to clean rooms occupied by a patient with C. difficile.
Have you seen the December issue of PIDJ? Interesting article about increase in C. difficile in children.
Kris Bryant