Article in Japanese

Clinical features of Clostridioides difficile infection in pediatric specialist medical facilities

Ryutaro Saura^1）, Kimihiro Taniguchi^2）, Masatoshi Nozaki^2）, Yuya Okamoto^3）, Shin‑ichiro Hagiwara^1）, Yuri Etani^1）

The current status of pediatric Clostridioides difficile （CD） infection （CDI） in Japan remains unclear. We conducted a retrospective cohort study to elucidate the changes over time in the number of pediatric patients with CDI and the appropriateness of testing and treatment at pediatric specialist medical facilities. Between January 2016 and December 2022, 313 patients（806 samples） were tested for CD toxin, with CD toxin detected in 41 patients （56 samples）. The number of CD toxin tests decreased over time, but the positivity rate increased. Among 34 patients （47 samples） diagnosed with CDI and receiving treatment, 33 （97％） had underlying diseases, including 16 （47％） with hematological or oncological diseases, and 13 （38％） with gastrointestinal diseases. For the initial treatment of CDI, 22 patients （65％） received oral metronidazole （MNZ）, 10 （29％） received intravenous MNZ, and 2 （6％） received oral vancomycin （VCM）. All patients were successfully treated, with no treatment failures. Recurrence occurred in 8 patients （24％）, with 2 experiencing 2 or more recurrences. When the initial treatment was oral MNZ, intravenous MNZ, or oral VCM, recurrence occurred in 1 patient （4.5％）, 6 patients （60％）, and 1 patient （50％）, respectively.
Most patients with CDI in pediatric specialist medical facilities had underlying diseases, and all patients were successfully treated, even when MNZ was the primary initial treatment. However, these results suggest that recurrence may be more frequent with intravenous MNZ.

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1）Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women’s and Children’s Hospital
2）Department of Perinatal and Pediatric Infectious Diseases, Osaka Women’s and Children’s Hospital
3）Clinical Laboratory Center, Osaka Women’s and Children’s Hospital

Key words	children, Clostridioides difficile, Metronidazole, Vancomycin, Recurrence
Received	June 28, 2024
Accepted	January 8, 2025

37 (1)：15─24,2025