Clostridioides (Clostridium) difficile infection (CDI)

[Clostridium difficile in paediatric populations | Canadian Paediatric Society]

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- NB: Clostridioides (Clostridium) difficile testing is not recommended in children < 12 months old. Colonization with this organism and toxin detection found in up to 60% of healthy neonates, 33% of infants & toddlers < 2 y.o., and 8% of older children.

Definition:

- presence of diarrhea (≥ 3 unformed stools in ≤ 24 hours) and either:

• stool test positive for toxigenic Clostridioides (Clostridium) difficile and its toxins
  or

• colonoscopic or histopathologic findings of pseudomembranous colitis.

- History of treatment with antibiotics, proton pump inhibitors (PPIs), or antineoplastic agents within previous 8 weeks is also present in almost all patients.

- Discontinue antibiotics if possible, especially cephalosporins and clindamycin, as these agents have been associated with the highest risk of CDI. If not possible, consider changing to lower CDI risk group of antibiotics if appropriate (e.g. aminoglycosides, TMP/SMX (> 1 month old), tetracyclines (> 8 years old), and/or metronidazole). 

- PPIs/H₂ blockers are associated with a 2-3 fold increased risk for CDI, and recurrent CDI. Assess need for use, or continued use, of these agents vs. benefit and discontinue if possible.

- Do NOT use antidiarrheals, e.g. loperamide (Imodium®), diphenoxylate (Lomotil®) as they may obscure symptoms and precipitate toxic megacolon.

- Vancomycin IV not effective. Metronidazole IV of uncertain efficacy (only use if very strict NPO or in combination for severe/toxic megacolon).

- Do not submit post treatment stool sample if asymptomatic and/or formed stools as toxin may persist for weeks post treatment.

Infection Control:

• Hospitalized patients with CDI should be isolated with contact precautions.

• Strict adherence to handwashing with soap and water essential (alcohol does not kill Clostridioides (Clostridium) difficile spores).