Written by Clay Smith
C. difficile colonization is very high in children under a year old and decreases with age.
Why does this matter?
We’ve all seen it. Dr. Mimo Zařízení* sends in a healthy looking 6 month old with a few days of loose stool for admission with “C. diff” after a stool multiplex PCR panel was positive…another casualty in the war on poop. Problem is, how many perfectly healthy babies are crawling around with C. difficile colonization? That’s what they set out to find in this exhaustive systematic review.
*I think this means “outside facility” in Czech. If you speak Czech and this is wrong, Google Translate and I apologize, but what a great sounding name, right?!
It’s not that difficile
This was a systematic review of 95 studies, 19,186 patients, all of whom were asymptomatic (no diarrhea) and under the age of 18 years. C. diff detection was highest among asymptomatic infants 6-12 months at 41% (14% toxigenic strain) and was 12% (5% toxigenic strain) among children ages 5-18 years. There were some regional variations, with colonization rates lower in North and South America compared with Europe and the Western Pacific. When interpreting C.difficile testing in children, we have to take the high rate of colonization into consideration. This study affirms the IDSA recommendation to avoid testing kids under a year of age and only test kids over 12 months if other causes of diarrhea have been excluded. Most studies were high quality and at low risk of bias, but 42 of the 95 had at least one quality or bias issue.
Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2021 Aug 2;e212328. doi: 10.1001/jamapediatrics.2021.2328. Online ahead of print.