Gut superbug threat to children, Canadian pediatricians warned

Infection is increasingly being reported in kids who have been prescribed antibiotics

Children of all ages who receive even a single prescription for an antibiotic are at risk of the toxic gut infection C. difficile, the nation’s pediatricians are being warned. Once thought mainly a problem for elderly people treated in hospital, C. difficile is now increasingly being reported in children, according to a new position statement on C. difficile published Friday by the Canadian Paediatric Society in the journal, Paediatrics & Child Health.

The document, which provides recommendations on the diagnosis, treatment and prevention of C. diff in children, is also the latest to appeal to doctors to curb their use of antibiotics, which can kill off normal, healthy gut bacteria and allow toxin- spewing C. difficile spores to have a “heyday,” said Dr. Joan Robinson, chair of the pediatric society’s infectious diseases and immunization committee.

We need to decrease the prescribing of antibiotics to patients who do not really need them, because you can get C. diff from even just one dose of an antibiotic. DR. JOAN ROBINSON CHAIR OF THE PEDIATRIC SOCIETY’S INFECTIOUS DISEASES AND IMMUNIZATION COMMITTEE

The bacteria multiply, causing swelling and irritation of the colon, a condition known as colitis. The inflammation can cause diarrhea, fever and abdominal cramps.

“With incredibly severe cases you can actually end up with perforation of the bowel,” Robinson said. Bowel contents can leak from the intestine into the abdominal cavity, triggering serious and potentially life- threatening infections. People sometimes end up in kidney failure or septic shock, although severe and fatal infections in children are rare.

“I think pediatricians are getting way more questions about C. diff than they used to and I think there’s more awareness of it among pediatricians and family doctors,” Robinson said. ” They are ordering more testing and recognizing more cases, and then wonder how they’re supposed to treat them.”

Drug- resistant strain

C. difficile spores are shed through feces. People can get infected if they touch contaminated surfaces, such as toilets, bedpans and door handles, and then their mouths. Hospital staff can spread the infection between patients if their hands are contaminated.

But growing numbers of children are also being infected outside of hospitals, experts say.

In addition, a new and highly drug- resistant strain behind an outbreak of C. difficile in Montreal in 2003 has spread widely in several parts of the world, including Canada, Robinson’s committee writes.

In one Canadian study, adults aged 60 to 90 infected with the hyper- virulent strain of C. diff were twice as likely to die or develop severe disease compared with people infected with different strains.

“While outbreaks and severe disease have been reported mostly in adults, pediatric disease is also being reported,” according to the CPS position statement.

C. difficile was once thought rare in infants. New research is now challenging that assumption.

In one U. S. study, 26 per cent of infections in children occurred in those younger than one year of age; five per cent occurred in babies younger than one month.

Aff ected children

Another study involving 200 Quebec children treated for C. difficile- associated diarrhea between February 2000 and November 2003 found that the median age of the children was 2.6 years.

The vast majority had been exposed to antibiotics or hospitalized within the previous one to two months.

In Ottawa, the Children’s Hospital of Eastern Ontario reported an outbreak of C. difficile in November 2011 after discovering three patients with the infection. All three were on the same ward.

The affected children were isolated in private rooms and special precautions, including enhanced cleaning and gloves and gowns for all health care workers entering the rooms, were taken to reduce the risk of transmission, said hospital spokeswoman Eva Schacherl.

“To prevent spread of C. difficile in the hospital, we continue to take enhanced precautions with all diarrhea cases, as well as with confirmed C. difficile cases,” she said.

The hospital reported five cases of C. difficile for 2012- 13, compared to 20 cases in 201112.

Decrease antibiotic use

Doctors should suspect C. difficile in any child who is receiving or who has received antibiotics within the previous 12 weeks and who has bloody diarrhea, fever and abdominal pain, according to the CPS guidelines.

“The key advice to physicians is that we need to promote excellent hand washing by all health care workers in the hospital,” Robinson said.

“The second really important rule is that we need to decrease the prescribing of antibiotics to patients who do not really need them, because you can get C. diff from even just one dose of an antibiotic,” she said.

For example, antibiotics are often prescribed to children for sore throats, even though “at least half the time when people come in with all the right symptoms and it looks like strep throat, it’s not strep throat. It’s viral,” Robinson said.

“Very often parents are actually quite relieved when you explain their child does not need an antibiotic.”