[Clostridium difficile associated diarrhea in children].

INTRODUCTION

Clostridium difficile is the most commonly isolated organism in antimicrobial and health care-associated diarrhea and is growing in relevance in community-acquired infections. It is a Gram-positive bacillus acquired via the fecal-oral route in the community and in hospital setting.

EPIDEMIOLOGY: 0.6 to 2.1% worldwide incidence, mortality ~ 1-5%. COLONIZATION: High rates of asymptomatic colonization in healthy people, 37% in children: its presence in stools is of controversial significance. Risk factors in children are prior exposure to antibiotics, recent hospitalization, immunosuppression or inflammatory bowel disease.

CLINICAL MANIFESTATIONS: Secondary to intestinal involvement due to toxin production, ranging from asymptomatic colonization to fulminant disease.

DIAGNOSIS: Clinical diagnostic criteria plus high sensitivity and specificity laboratory certification. Recommendations AAP (American Academy of Pediatrics): under 1 year, avoid routine study, only in Hirschsprung disease and/or nosocomial outbreak, 1-3 year, a (+) result suggests C. difficile associated diarrhea (CDAD) is possible, and in children older than 3 years interpretation is equal to adults.

MANAGEMENT: Antimicrobial suspension, oral metronidazole as first line in mild to moderate CDAD, and oral or enema vancomycin or associated with intravenous metronidazole only in severe cases. Duration 10 days.

PREVENTION: Antimicrobial control programs and environmental management.

CONCLUSION

Given the increasing complexity of pediatric patients it is important to deepen the knowledge on this microorganism and its clinical manifestations, as its incidence, morbidity and mortality are increasing.