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Co-infection as a confounder for the role of Clostridium Difficile infection in children with diarrhoea: a summary of the literature

Co-infection as a confounder for the role of Clostridium Difficile infection in children with diarrhoea: a summary of the literature
Co-infection as a confounder for the role of Clostridium Difficile infection in children with diarrhoea: a summary of the literature
Although Clostridium difficile is a major cause of antibiotic-associated diarrhoea in adults, the incidence and severity of C. difficile infection (CDI) in children is unclear. One complicating factor in assessing the role of CDI in children is the possibility of co-infection with other gastrointestinal pathogens. In this review, we summarise the literature concerning C. difficile co-infections in young children, in an attempt to discuss the rate of co-infections and their potential role in the severity of CDI clinical presentation. We identified 31 studies where co-infections were analysed, comprising 1,718 patients with positive C. difficile tests. The pooled percentage of reported co-infections was 20.7 % (range 0–100 %). Viral co-infections were most commonly reported (46 %), with bacteria and parasites accounting for 14.9 % and 0.01 % of cases, respectively. However, the panel of co-infections tested for varied considerably among studies and 38 % of stated co-infections did not have a pathogen reported. Substantial variation in how and when tests for gastrointestinal co-infections are carried out, small sample sizes and a lack of clear CDI case definitions preclude meaningful conclusions on the true rate of co-infections in this patient population. This review suggests that co-infections may be common in children with diarrhoea who tested positive for C. difficile. Given a lack of CDI case definitions, especially in young children under the age of 5 years, a broad panel of pathogens should be tested for to exclude other microbiological causes. However, the summarised poor quality of the available literature on this subject highlights a need for further studies.
0934-9723
1281-1287
de Graaf, Hans
447e78ed-346f-45bb-9238-fce2118d5559
Pai, S.
835dc77b-8286-41da-b95f-32daede1bd2c
Burns, D.A.
030cb4ce-f643-4b71-a0df-1f3d66ff9c75
Karas, J.A.
7186baad-e61e-4c74-90d1-6887ad887185
Enoch, D.A.
194e5a02-444f-4915-9c17-0db51b5eacf7
Faust, S.N.
f97df780-9f9b-418e-b349-7adf63e150c1
de Graaf, Hans
447e78ed-346f-45bb-9238-fce2118d5559
Pai, S.
835dc77b-8286-41da-b95f-32daede1bd2c
Burns, D.A.
030cb4ce-f643-4b71-a0df-1f3d66ff9c75
Karas, J.A.
7186baad-e61e-4c74-90d1-6887ad887185
Enoch, D.A.
194e5a02-444f-4915-9c17-0db51b5eacf7
Faust, S.N.
f97df780-9f9b-418e-b349-7adf63e150c1

de Graaf, Hans, Pai, S., Burns, D.A., Karas, J.A., Enoch, D.A. and Faust, S.N. (2015) Co-infection as a confounder for the role of Clostridium Difficile infection in children with diarrhoea: a summary of the literature. European Journal of Clinical Microbiology & Infectious Diseases, 34 (7), 1281-1287. (doi:10.1007/s10096-015-2367-0). (PMID:25926302)

Record type: Article

Abstract

Although Clostridium difficile is a major cause of antibiotic-associated diarrhoea in adults, the incidence and severity of C. difficile infection (CDI) in children is unclear. One complicating factor in assessing the role of CDI in children is the possibility of co-infection with other gastrointestinal pathogens. In this review, we summarise the literature concerning C. difficile co-infections in young children, in an attempt to discuss the rate of co-infections and their potential role in the severity of CDI clinical presentation. We identified 31 studies where co-infections were analysed, comprising 1,718 patients with positive C. difficile tests. The pooled percentage of reported co-infections was 20.7 % (range 0–100 %). Viral co-infections were most commonly reported (46 %), with bacteria and parasites accounting for 14.9 % and 0.01 % of cases, respectively. However, the panel of co-infections tested for varied considerably among studies and 38 % of stated co-infections did not have a pathogen reported. Substantial variation in how and when tests for gastrointestinal co-infections are carried out, small sample sizes and a lack of clear CDI case definitions preclude meaningful conclusions on the true rate of co-infections in this patient population. This review suggests that co-infections may be common in children with diarrhoea who tested positive for C. difficile. Given a lack of CDI case definitions, especially in young children under the age of 5 years, a broad panel of pathogens should be tested for to exclude other microbiological causes. However, the summarised poor quality of the available literature on this subject highlights a need for further studies.

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Accepted/In Press date: 19 March 2015
e-pub ahead of print date: 1 May 2015
Organisations: Faculty of Medicine

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Local EPrints ID: 377058
URI: http://eprints.soton.ac.uk/id/eprint/377058
ISSN: 0934-9723
PURE UUID: 11dbd490-13c7-46bc-bd68-209af55ff9fc
ORCID for S.N. Faust: ORCID iD orcid.org/0000-0003-3410-7642

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Date deposited: 18 May 2015 13:41
Last modified: 18 Feb 2021 17:07

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Contributors

Author: Hans de Graaf
Author: S. Pai
Author: D.A. Burns
Author: J.A. Karas
Author: D.A. Enoch
Author: S.N. Faust ORCID iD

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