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01-03-2018 | Original Article

Investigation of Clostridium difficile ribotypes in symptomatic patients of a German pediatric oncology center

Authors: Arne Simon, Markus Mock, Norbert Graf, Lutz von Müller

Published in: European Journal of Pediatrics | Issue 3/2018

Abstract

In a German pediatric oncology unit, the attending physicians diagnosed 27 cases of Clostridium difficile-associated disease (CDI) from January 01, 2010 to October 31, 2013. This refers to a CDI incidence density of 2.0/1000 inpatient days. According to the hospital hygiene standard, symptomatic patients with CDI were kept in contact isolation. Most patients (median age 8.2 years) suffered from acute lymphoblastic leukemia; 88.9% were treated with broad-spectrum antibiotics during the preceding 4 weeks. 29.6% received intravenous morphine/metamizole and parenteral nutrition due to severe chemotherapy-induced mucositis. None of the patients experienced severe complications such as lower gastrointestinal tract bleeding, sepsis, or toxic megacolon. Genotyping of the isolates derived from symptomatic patients revealed many different ribotypes without detection of the hypervirulent 027 strain and did not point at hospital transmission as an important promoter of CDI in our unit.

Conclusion: Under strict standard hygiene and contact isolation for symptomatic patients, genotyping of clinical isolates revealed that in pediatric cancer patients, CDI is not necessarily based on nosocomial transmission. The rate of CDI-related severe complications was low.

What is Known:

• Pediatric cancer patients face an increased risk of Clostridium difficile-associated disease due to immunosuppression, cancer chemotherapy, mucositis, and dysbiosis following intravenous broad-spectrum antimicrobial treatment.

• C. difficile may be transmitted from patient to patient.

What is New:

• Under strict standard hygiene and contact isolation for symptomatic patients, genotyping of clinical isolates revealed that in pediatric cancer patients, CDI is not necessarily based on nosocomial transmission.

• The rate of CDI-related severe complications was low.

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Title: Investigation of Clostridium difficile ribotypes in symptomatic patients of a German pediatric oncology center
Authors: Arne Simon
Markus Mock
Norbert Graf
Lutz von Müller
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 3/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-017-3070-1

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Investigation of Clostridium difficile ribotypes in symptomatic patients of a German pediatric oncology center

Abstract

Keynote webinar | Spotlight on medication adherence

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