Age-related clinical and therapeutic differences during a hospital outbreak of Clostridioides difficile infection in Colombia.

BACKGROUND

Pediatric data on hospital-acquired Clostridioides difficile infection (HA-CDI) outbreaks in Latin America are scarce. We compared age-related clinical, microbiological, therapeutic, and outcome differences during a Colombian HA-CDI outbreak.

METHODS

We conducted a retrospective observational study at a 610-bed tertiary-care hospital in Medellín, Colombia, during an epidemiologically characterized HA-CDI outbreak (September 2017-March 2018). Cases required compatible diarrhea and real-time polymerase chain reaction detection of C difficile toxin genes.

RESULTS

Twenty-five HA-CDI cases were identified; 15 (60%) occurred in children. Children developed symptoms earlier after admission than adults (median 6 vs 13 days) and more often presented with fever and tachycardia. Molecular characterization identified C difficile ribotype 027, corresponding to the 027/NAP1/BI lineage, in 1 pediatric severe case. Ten-day treatment regimens were more frequent in children than adults (86.7% vs 40.0%; P = .01), while diarrhea duration was similar. One pediatric recurrence occurred; no CDI-attributable mortality was observed.

DISCUSSION: Pediatric predominance may reflect age-related host-microbiota dynamics, colonization patterns, antibiotic exposure, and diagnostic ascertainment. Treatment findings represent local practice, not comparative effectiveness.

CONCLUSIONS

This outbreak supports age-stratified HA-CDI surveillance, diagnostic stewardship, molecular surveillance, pediatric-adapted antimicrobial stewardship, and locally adapted infection-prevention strategies.