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NPPG 2008: Detection of Clostridium difficile in children

Karen Whitehouse, pharmacist, and Patricia Fenton, consultantmicrobiologist, both from Sheffield Children’s Hospital, gave a jointposter presentation on the detection of Clostridium difficile toxin inpaediatric patients, at the annual Neonatal and Paediatric PharmacistsGroup (NPPG) conference that was held in Sutton Coldfield from 14–16November 2008

by Peter Mulholland

Karen Whitehouse, pharmacist, and Patricia Fenton, consultant microbiologist, both from Sheffield Children’s Hospital, gave a joint poster presentation on the detection of Clostridium difficile toxin in paediatric patients, at the annual Neonatal and Paediatric Pharmacists Group (NPPG) conference that was held in Sutton Coldfield from 14–16 November 2008.

They explained that, since April 2007, the Department of Health (England and Wales) has demanded that mandatory surveillance of C difficile associated diarrhoea (CDAD) be extended from patients over 65 years of age to include all patients over two years of age.

They believe there is little published work on the epidemiology of CDAD in children, although it is accepted that toxin-producing C difficile may form part of the normal bowel flora in neonates and infants.

They talked about how staff at Sheffield Children’s Hospital carried out a retrospective audit of all patients over two years of age with C difficile toxin detected in the faeces, with the aim of trying to improve understanding of the epidemiology of CDAD in children and report on CDAD surveillance in a specialist children’s trust over a 15-month period.

They discovered that the greatest incidence of CDAD occurred in the haematology and oncology patient group. These patients have frequent hospital visits (outpatient and inpatient) and are exposed to a number of unavoidable courses of antibiotics.

The chemotherapy itself also disrupts gut flora, so this patient group has been identified as the highest risk of getting CDAD at Sheffield Children’s Hospital. The age of CDAD episodes exhibited two small peaks, one between the ages of two and three years and another between the ages of 12 and 13 years.

The peak between the ages of two and three years is, perhaps, part of normal gut flora development, whereas identification of C difficile toxin in the older children may be similar to CDAD found in adults.

Miss Whitehouse and Dr Fenton thought that more work needs to be done to ensure that targets are not set for reduction of cases of a disease that may not actually exist in certain age groups.

Citation: The Pharmaceutical Journal URI: 10043456

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