Updated Management Guidelines for Clostridioides difficile in Paediatrics

Pathogens

Pierpacifico Gismondi¹  Margherita Gnocchi¹  Martina Gagliardi¹  Susanna Esposito¹  GianLuigi de’ Angelis²  Federica Gaiani² 

[1] Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;Unit of Gastroenterology and Digestive Endoscopy, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;

关键词: Clostridioides difficile;    Clostridium difficile infection;    faecal microbiota transplant;    fidaxomicin;    vancomycin;   

DOI  :  10.3390/pathogens9040291

来源: DOAJ

【 摘 要 】

Clostridioides difficile, formerly known as Clostridium difficile, causes infections (CDI) varying from self-limited diarrhoea to severe conditions, including toxic megacolon and bowel perforation. For this reason, a prompt diagnosis is fundamental to early treatment and the prevention of transmission. The aim of this article is to review diagnostic laboratory methods that are now available to detect C. difficile and to discuss the most recent recommendations on CDI treatment in children. Currently, there is no consensus on the best method for detecting C. difficile. Indeed, none of the available diagnostics possess at the same time high sensitivity and specificity, low cost and rapid turnaround times. Appropriate therapy is targeted according to age, severity and recurrence of the episode of infection, and the recent availability of new antibiotics opens new opportunities. De-escalation of antibiotics that are directly associated with CDI remains a priority and the cautious use of probiotics is recommended. Vancomycin represents the first-line therapy for CDI, although in children metronidazole can still be used as a first-line drug. Fidaxomicin is a new treatment option with equivalent initial response rates as vancomycin but lower relapse rates of CDI. Faecal microbiota transplantation should be considered for patients with multiple recurrences of CDI. Monoclonal antibodies and vaccines seem to represent a future perspective against CDI. However, only further studies will permit us to understand whether these new approaches could be effective in therapy and prevention of CDI in paediatric populations.

【 授权许可】

Unknown