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2017 ; 36
(4
): 379-383
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Recurrent Clostridium difficile Infection in Children: Patient Risk Factors and
Markers of Intestinal Inflammation
#MMPMID27977555
Nicholson MR
; Crews JD
; Starke JR
; Jiang ZD
; DuPont H
; Edwards K
Pediatr Infect Dis J
2017[Apr]; 36
(4
): 379-383
PMID27977555
show ga
BACKGROUND: The management of Clostridium difficile infection (CDI) in children
is complicated by recurrence rates of 20%-30%. The identification of risk factors
associated with recurrent disease might allow early recognition of those children
at highest risk. METHODS: Pediatric patients with CDI were identified through
clinical laboratory records at 2 tertiary-care children's hospitals from March
2013 through May 2014. Subjects were enrolled and followed for 60 days to assess
for recurrent CDI (rCDI). Blood samples were obtained at enrollment to evaluate
host interleukin (IL)-8 polymorphisms and anti-toxin A antibody levels; stool
samples were obtained for inflammatory markers (lactoferrin, calprotectin, IL-8)
and C. difficile ribotype 027 strain status. Thirty days post enrollment, another
serum sample was obtained to compare antibody responses. RESULTS: Of the 28
pediatric patients enrolled, 27 completed follow-up and 8 (30%) experienced rCDI.
At enrollment, children with malignancy had significantly lower stool
calprotectin, lactoferrin and IL-8 than those without malignancy. There was a
trend toward increased stool inflammatory markers in those who later developed
rCDI. The IL-8 A/A genotype was not associated with recurrent disease. No
patients were found to have ribotype 027 or an antibody increase to toxin A.
CONCLUSIONS: The rate of rCDI in our pediatric cohort was 30%. Children with rCDI
had a trend toward higher fecal inflammatory markers with the initial infection,
and these values were lower in children with malignancy. Fecal lactoferrin,
calprotectin and IL-8 should be further studied to determine their value in
predicting the risk of rCDI in children.