Clostridiodes difficile Infection in Pediatric Oncologic Patients: Characteristics of a 6 Month Period Review
Bonilla Anibal, Mera Mónica, García Gustavo, Freire DoloresAbstract
Background
Clostridioides difficile (C. difficile) is one the leading causes of nosocomial diarrhea, however, testing methods vary according to availability of resources. In pediatric oncologic patients, this infection has been scantly studied in limited resource settings. We present the clinical, laboratory, imaging and microbiological characteristics of pediatric oncologic patients with C. difficile infection.
Methods
Prospective evaluation of pediatric (age ≤18 years) patients with diarrhea (liquid or loose stools) and a positive result of C. difficile real time PCR using the Biofire® gastrointestinal panel from April to October 2024, while hospitalized in the pediatric department at Solca Guayaquil.
Results
Of 105 tests performed during the studied period, we found 16 patients with 22 (21%) episodes of diarrhea with a C. difficile positive test. Mean age was 7.6 ± 5.9 years divided in 1 (6%) infant, 8 (50%) preschoolers, 2 (13%) school aged and 5 (31%) teenagers. Of them 12 (75%) were girls and 13 (81%) had leukemia. Duration of hospitalization at time of positive test was 16,5 ± 14,2 days. Regarding clinical presentation, 2 (13%) cases had loose but not liquid stools. Duration of liquid stools went from 1 to 8 days with a median of 2 days. Blood in stools was present in 3 (19%), fever > 38.5 °C in 5 (31%), abdominal pain in 11 (69%) cases respectively. Regarding laboratory, 9 (56%) patients had ANC < 100 cells/mcL and 3 (19%) between 100 and 500 cells/mcL. CRP was below cutoff value in 6 (38%) patients. C. difficile was detected as a single organism in 6 (38%) patients. Bacteremia was present 1 (6%) patient and 1 (6%) had Candidemia. The recommended abdominal US was not performed in 2 (13%) patients. Colitis was observed in 5 (31%) patients 3 (19%) needed abdominal CT scan. All patients received metronidazole, 14 (88%) intravenously of which 1 (7%) switched to oral near the end of therapy. Relapse occurred in 5 (31%) patients. There were no surgical interventions or deaths.
Conclusion
C. difficile infection is prevalent in pediatric oncologic patients with diarrhea and abdominal pain or fever. We observed it more frequently in girls and infants. Though not fatal cases were observed, prolongation of chemotherapy and length of hospital stay need to be considered.