Curr Treat Options Peds (2018) 4:255–269
Hospital Medicine (A Statile and N Unaka, Section Editors)
C. difficile Infection
in Children: What’sNew?
Jennifer Hellmann, MD
Daniel Mallon, MD, MSHPEd
Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s
Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
Published online: 23 April 2018
* Springer International Publishing AG, part of Springer Nature 2018
This article is part of the Topical Collection on Hospital Medicine
Keywords C. difficile infection
Fecal microbial transplant (FMT)
Purpose of review The purpose of this review is to present the epidemiology of Clostridium
difficile infection in children and to present a number of clinical challenges in diagnosis
and therapy that are unique to the pediatric population.
Recent findings Current research has focused on novel methods of prevention and treat-
ment of C. difficile infection in children. Fecal microbial transplantation (FMT) for recurrent
C. difficile is increasingly prescribed for children, and recent data includes comparisons of
effectiveness and tolerability between methods of delivery.
Summary The incidence of C. difficile infection in children has risen in recent decades both
in healthy children and those with underlying comorbidities. Antibiotic use, acid suppres-
sive medication use, and the presence of enteric feeding tubes are well-documented risk
factors. There is no standard method of testing for C. difficile infection in children, which
complicates epidemiological tracking and detection of active disease versus asymptomatic
colonization. First-line therapy for initial infection in children is metronidazole, while
vancomycin may be reserved for those with severe infection or high risk of complications.
Recurrence of infection is frequent, and while repeat courses of antibiotics may be effective,
fecal microbial transplant should be considered a safe and efficacious alternative therapy.
Clostridium difficile is a gram-positive, toxin-producing
bacillus thatmay residein ahealthy pediatric intestinal
microbiome. However, the microbial balance can tip
such that C. difficile causes diarrheal illness ranging
from mild, self-limited disease to pseudomembranous
colitis, toxic megacolon, septic shock, and even death.
The incidence of C. difficile infection (CDI) in children
in the United States (US) has risen over the last two
decades, particularly among high risk groups such as