Key Points
➤ Clostridioides difficile infection (CDI) is among the most prevalent
and important healthcare-associated infections (HAIs) affecting
children, but reports of CDI in infants <12 months of age are rare,
perhaps because of a relative resistance to the effects of C. difficile
toxins or other protective factors in the intestinal environment of
infants.
➤ Additionally, high colonization rates in infants (~35%) make
interpretation of positive C. difficile tests in neonatal intensive care
units (NICU) patients uniquely challenging.
➤ For these reasons, the authors do not recommend routine testing for
C. difficile in NICU patients.
• NICU patients should be evaluated for other more common causes of diarrhea.
Testing for CDI
➤ The authors advise against routine testing for CDI in NICU patients
because of the high prevalence of asymptomatic carriage of toxigenic
C. difficile in infants <12 months of age. When C. difficile or its toxins
are detected in the stool of an infant, clinicians may not be able to
determine with certainty that a positive result represents CDI.
➤ Clinicians should test NICU patients for CDI only if there is evidence
of pseudomembranous colitis or if the patient has clinically
significant diarrhea and other noninfectious and infectious causes of
diarrhea have been excluded.
Diagnosis
