Recently, the recommendations for the treatment of Clostridioides difficile infection (CDI) have been up-dated. However, in addition to the clinical efficacy data, the drug of choice should ideally... Show moreRecently, the recommendations for the treatment of Clostridioides difficile infection (CDI) have been up-dated. However, in addition to the clinical efficacy data, the drug of choice should ideally represent op-timal antimicrobial stewardship, with an emphasis on rapid restoration of the gut microbiota to mini-mize the risk of infection relapses. Oral administration of metronidazole results in low concentration in stool, and interaction with fecal microbiota reduces its antimicrobial bioactivity. Reported elevated min-imum inhibitory concentrations of metronidazole in epidemic C. difficile ribotypes and the emergence of plasmid-mediated resistance to metronidazole represent additional potential risks for clinical failure. If metronidazole is the only CDI treatment option, antimicrobial susceptibility testing on agar contain-ing heme should be performed in C. difficile isolate. Compared with metronidazole, oral vancomycin and fidaxomicin reach very high concentrations in the stool, and therefore can quickly reduce C. difficile shed-ding. Health care facilities with higher CDI incidence and/or occurrence of epidemic ribotypes should not use metronidazole because prolonged C. difficile shedding can increase the risk for further C. difficile transmission. Only fidaxomicin has a narrow spectrum of antimicrobial activity, which might be, together with persistence on spores, the main contributing factor to reduce the recurrent CDI rates.(c) 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) Show less
Background: Clostridioides difficile infections (CDI) are traditionally attributed to an older adult patient group but children can also be affected. Although the causative pathogen is the same in... Show moreBackground: Clostridioides difficile infections (CDI) are traditionally attributed to an older adult patient group but children can also be affected. Although the causative pathogen is the same in both populations, the management of CDI may differ.Objectives: To discuss the current literature on CDI in the paediatric population and to provide CDI di-agnostics and treatment guidance.Sources: The literature was drawn from a search of PubMed from January 2017 to July 2021.Content: In the paediatric population, laboratory diagnostics for CDI should preferably be combined with laboratory diagnostics for other gastrointestinal pathogens. Coinfections of CDI are also possible. Though the detection of toxigenic C. difficile using a molecular assay may simply reflect colonisation rather than infection, detection of C. difficile free toxins A/B in faeces is much more indicative of true infection. CDI in children below 2 years of age and in the absence of risk factors is very difficult to diagnose and requires careful clinical judgement pending additional studies.Fidaxomicin has been shown to be superior to vancomycin with a sustained clinical response up to 30 days after the end of CDI treatment in children. Metronidazole is less effective than vancomycin in adults and there are no supporting data for its use in children. In recurrent CDI, treatment should be adjusted according to the drug or drug regimen used for the treatment of a previous episode(s). In multiple recurrent CDI, faecal microbiota transplantation can be effective.Implications: If CDI laboratory testing is indicated in children with diarrhoea, the likelihood of C. difficile colonisation and coinfection with other intestinal pathogens should be considered. The currently available data support a change in the treatment strategy of CDI in children. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. Show less
Wingen-Heimann, S.M.; Prehn, J. van; Kuijper, E.J.; Vehreschild, M.J.G.T. 2021
