UroToday - A study by Dr. Jason Kim et al. evaluated the epidemiological characteristics of clostridium difficile infections in hospitalized children. They identified almost 5,000 patients with C difficile-associated disease. They found that the annual incidence of the disease increased as well as the number of cases per inpatient days. Over two-thirds of these patients had underlying chronic medical conditions.

In their study, although the incidence was rising, the overall morbidity and mortality did not increase during the study timeframe. One of the more difficult aspects of C diff infections is the diagnosis. Some children present with either just a fever or vague abdominal pain as their only symptomatology. As we are becoming more aware of C diff and its associated symptoms, our diagnostic capabilities have improved. I always wonder if this is part of the increased incidence that we are seeing. Is it truly an incidence in the rise of C diff itself or is it because we are becoming more attuned with the diagnosis?

It is important, especially in our surgical patients who receive antibiotic therapy, that the diagnosis of C diff always be in the differential diagnosis, especially when the children are not behaving as they should after a surgical intervention.

Kim J, Smathers SA, Prasad P, Leckerman KH, Coffin S, Zaoutis T
Pediatrics. 2008 Dec;122(6):1266-70.
doi:10.1542/peds.2008-0469

UroToday Medical Editor Pasquale Casale, MD

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