Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Epidemiology and Clinical Characteristics of Clostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections

소아에서 발생한 Clostridium difficile 관련 질환의 역학과 임상양상: 지역사회감염과 원내감염의 비교

  • Cho, Hye-Jung (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Ryoo, Eell (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Sun, Yong-Han (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Cho, Kang-Ho (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Son, Dong-Woo (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science) ;
  • Tchah, Hann (Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science)
  • 조혜정 (가천의과학대학교 의학전문대학원 소아과학교실) ;
  • 류일 (가천의과학대학교 의학전문대학원 소아과학교실) ;
  • 선용한 (가천의과학대학교 의학전문대학원 소아과학교실) ;
  • 조강호 (가천의과학대학교 의학전문대학원 소아과학교실) ;
  • 손동우 (가천의과학대학교 의학전문대학원 소아과학교실) ;
  • 차한 (가천의과학대학교 의학전문대학원 소아과학교실)
  • Received : 2010.07.29
  • Accepted : 2010.08.27
  • Published : 2010.09.30
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Abstract

Purpose: Recent studies have reported an increase in the incidence of community-acquired Clostridium difficile-associated disease (CA-CDAD) among children. There is an overall lack of information on CA-CDAD in the pediatric population. The aim of our study was to compare the epidemiologic and clinical features between CA-CDAD and hospital-acquired C. difficile-associated disease (HA-CDAD) in children. Methods: We retrospectively reviewed the medical records of all patients who were diagnosed with C. difficile-associated disease (CDAD) at Gil Hospital between April 2008 and March 2009. The diagnosis of CDAD was made when patients with gastrointestinal symptoms had positive results for C. difficile toxins A and B assay or stool culture. Results: Sixty-one (male, 32 and female, 29) patients were included. The mean age was 3.79${\pm}$4.54 years. Of the 61 patients, 22 (36.1%) were <1 year of age. Twenty-three patients (37.7%) had a history of antibiotic exposure in the previous 3 months. Forty-one patients (67.2%) were diagnosed with CA-CDAD. There were no significant differences in age, gender, symptoms, laboratory findings, recovery period, complications, and recurrence between the CA-CDAD and HA-CDAD groups. On the other hand, exposure to antibiotics was significantly more frequent among patients in the HA-CDAD group (p=0.005). Conclusion: This study suggests that the occurrence of CA-CDAD is increasing in the pediatric population, especially in younger children with no history of exposure to antibiotics and in outpatients. Awareness of the increasing incidence of CA-CDAD and prompt investigation of C. difficile in susceptible patients is needed to avoid misdiagnosis and for appropriate therapy.

목 적: 최근 소아에서의 지역사회 획득 Clostridium difficile 관련질환(CDAD)은 증가하는 것으로 보고된다. 그러나 아직 소아에서 발생한 CDAD에 대한 정보는 부족한 실정이다. 저자들은 소아 CDAD환자에서 지역사회감염(CA-CDAD)과 병원감염(HA-CDAD)의 역학과 임상양상의 차이를 비교하여 알아보고자 하였다. 방 법: 2008년 4월부터 2010년 3월까지 가천의대 길병원 소아청소년과에 내원한 환자들의 의무기록을 후향적으로 분석하여 소화기계 증상을 가지고 있으면서 C. difficile 독소 A, B 또는 C. difficile 배양검사에서 양성으로 확인된 경우 CDAD로 진단하였다. 결 과: 총 61명(남 32, 여 29)의 환자가 연구에 포함되었고, 평균연령은 3.79${\pm}$4.54세였으며, 1세 미만이 22명(36.1%)으로 가장 많았다. 전체 중 23명(37.7%)의 환자만이 증상 발현 3개월 이내에 항생제를 투여 받은 적이있었다. 총 61명의 환자 중 CA-CDAD군이 41명, HA-CDAD군이 20명이었고, 나이, 성별, 증상, 검사실소견, 회복기간, 합병증 발생 및 재발률은 두 군 간에 유의한 차이가 없었으나 항생제 노출 여부는 HACDAD의 발생과 관련이 있었다. 결 론: 소화기계 증상을 가지고 외래에 내원한 영아와 어린 소아에서 항생제 노출력이 없는 CA-CDAD의 발생이 증가하고 있다. 신속하게 검사를 시행하는 것이 정확한 진단과 치료를 위해 요구된다.

Keywords

References

  1. Lee JH, Lee SY, Kim YS, Park SW, Jo SY, Ryu SH, et al. The incidence and clinical features of Clostridium difficile infection; single center study. Korean J Gastroenterol 2010;55:175-82. https://doi.org/10.4166/kjg.2010.55.3.175
  2. Kim BC, Yang HR, Jeong SJ, Lee KH, Kim JE, Ko JS, et al. Clostridium difficile colitis in childhood: associated antibiotics. J Korean Pediatr Gastroenterol Nutr 2002;5: 143-9.
  3. DuPont HL, Garey K, Caeiro JP, Jiang ZD. New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control. Curr Opin Infect Dis 2008;21:500-7. https://doi.org/10.1097/QCO.0b013e32830f9397
  4. Hookman P, Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol 2009;15:1554-80. https://doi.org/10.3748/wjg.15.1554
  5. Cohen MB. Clostridium difficile infections: emerging epidemiology and new treatments. J Pediatr Gastroenterol Nutr 2009;48(Suppl 2):63-5. https://doi.org/10.1097/MPG.0b013e3181a118c6
  6. Baker SS, Faden H, Sayej W, Patel R, Baker RD. Increasing incidence of community-associated atypical Clostridium difficile disease in children. Clin Pediatr (Phila) 2010;49:644-7. https://doi.org/10.1177/0009922809360927
  7. Byun TJ, Han DS, Ahn SB, Cho HS, Kim TY, Eun CS, et al. Clinical characteristics and changing epidemiology of Clostridium difficile-associated disease (CDAD). Korean J Gastroenterol 2009;54:13-9. https://doi.org/10.4166/kjg.2009.54.1.13
  8. Benson L, Song X, Campos J, Singh N. Changing epidemiology of Clostridium difficile-associated disease in children. Infect Control Hosp Epidemiol 2007;28: 1233-5. https://doi.org/10.1086/520732
  9. Sung NJ, Lee SG, Kim MJ, Kim YH, Yang S, Hwang IT, et al. The change of intestinal normal flora in neonates for seven days postnatally. Korean J Pediatr Gastroenterol Nutr 2006;9:162-8.
  10. Brook I. Clostridium difficile. In: Long SS, Pickering LK, Prober CG, editors. Principles and practice of pediatric infectious disease. 3rd ed. Philadelphia: Elsevier, 2008: 966-9.
  11. Pituch H. Clostridium difficile is no longer just a nosocomial infection or an infection of adults. Int J Antimicrob Agents 2009;33(Suppl 1):42-5.
  12. Park HS, Han DS. Is Clostridium difficile infection increasing in Korea? Korean J Gastroenterol 2010;55: 208-10. https://doi.org/10.4166/kjg.2010.55.3.208
  13. Zilberberg MD, Tillotson GS, McDonald C. Clostridium difficile infections among hospitalized children, United States, 1997-2006. Emerg Infect Dis 2010;16:604-9. https://doi.org/10.3201/eid1604.090680
  14. Jangi S, Lamont JT. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutr 2010;51:2-7. https://doi.org/10.1097/MPG.0b013e3181d29767
  15. Boenning DA, Fleisher GR, Campos JM, Hulkower CW, Quinlan RW. Clostridium difficile in a pediatric outpatient population. Pediatr Infect Dis 1982;1:336-8. https://doi.org/10.1097/00006454-198209000-00011
  16. Price EH, Wright VM, Walker-Smith JA, Tabaqchali S. Clostridium difficile and acute enterocolitis. Arch Dis Child 1988;63:543-5. https://doi.org/10.1136/adc.63.5.543
  17. Rexach CE, Tang-Feldman YJ, Cantrell MC, Cohen SH. Epidemiologic surveillance of Clostridium difficile diarrhea in a freestanding pediatric hospital and a pediatric hospital at a university medical center. Diagn Microbiol Infect Dis 2006;56:109-14. https://doi.org/10.1016/j.diagmicrobio.2006.03.002
  18. Cunningham R, Dial S. Is over-use of proton pump inhibitors fuelling the current epidemic of Clostridium difficile-associated diarrhoea? J Hosp Infect 2008;70:1-6.
  19. Lee YJ, Choi MG, Lim CH, Jung WR, Cho HS, Sung HY, et al. Change of Clostridium difficile colitis during recent 10 years in Korea. Korean J Gastroenterol 2010; 55:169-74. https://doi.org/10.4166/kjg.2010.55.3.169
  20. Shin BM, Yoo SJ, Oh HJ. Comparison of two enzyme immunoassay for detection of Clostridium difficile toxin A and toxin B. Korean J Lab Med 2009;29:122-6. https://doi.org/10.3343/kjlm.2009.29.2.122
  21. Chung DR. Diagnosis of Clostridium difficile-associated diarrhea. Korean J Med 2010;78:316-7.
  22. Forward LJ, Tompkins DS, Brett MM. Detection of Clostridium difficile cytotoxin and Clostridium perfringens enterotoxin in cases of diarrhoea in the community. J Med Microbiol 2003;52:753-7. https://doi.org/10.1099/jmm.0.05119-0
  23. Jang YH, Chung JW, Baek SM, Park SJ, Sung HS, Kim MN. Implementation of multiplex PCR for species identification and toxin typing in toxigenic Clostridium difficile Culture. Korean J Clin Microbiol 2009;12:11-6. https://doi.org/10.5145/KJCM.2009.12.1.11
  24. Park JH, Kang KJ, Kang YN, Kim AS, Hwang JB. Pseudomembranous colitis in children: experience of a university hospital in Korea. Korean J Pediatr 2010;53: 184-9. https://doi.org/10.3345/kjp.2010.53.2.184
  25. Spivack JG, Eppes SC, Klein JD. Clostridium difficileassociated diarrhea in a pediatric hospital. Clin Pediatr (Phila) 2003;42:347-52. https://doi.org/10.1177/000992280304200407
  26. Lowy I, Molrine DC, Leav BA, Blair BM, Baxter R, Gerding DN, et al. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med 2010; 362:197-205. https://doi.org/10.1056/NEJMoa0907635
  27. McFarland LV, Beneda HW, Clarridge JE, Raugi GJ. Implications of the changing face of Clostridium difficile disease for health care practitioners. Am J Infect Control 2007;35:237-53. https://doi.org/10.1016/j.ajic.2006.06.004

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