Discuss C. difficile intestinal colonization in newborns.
Newborns are most likely to have asymptomatic colonization with C. difficile; 37% of infants younger than 1 month of age are colonized, as well as 30% of children between the ages of 1 and 6 months and 14% of infants between the ages of 6 and 12 months.
It is recommended that physicians avoid routine C. difficile testing in children younger than 1 year of age because of the high rates of carriage, and even with a positive test, testing for other causes of diarrhea--particularly viral--is recommended before treating for C. difficile. In children aged 1-3 years, a positive test indicates possible infection; after 3 years of age, the carriage rate is similar to that in adults, such that a child 3 years of age or older with a positive test should be treated for C. difficile. Formula-fed infants are more likely than breastfed infants to be carriers of C. difficile (30% vs 14%).
Testing for cure after treatment of C. difficile is not recommended because the bacteria and its toxins are shed for weeks after diarrhea is resolved. The treatment for C. difficile is stopping any current antibiotics that are being used and starting metronidazole for a first episode, or oral vancomycin for severe disease or recurrence.
2021. "Clostridioides difficile (formerly Clostridium difficile)", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP