Diarrea asociada a Clostridium difficile en niños

Abstract

Introduction: Clostridium difficile is the most commonly isolated organism in antimicrobial and health careassociated 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.