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G440(P) To audit the management of clostridium difficile (c. difficile) infection in children
  1. R Atterby,
  2. S Bandi
  1. Childrens Hospital, Leicester Royal Infirmary, Leicester, UK

Abstract

Methods C. difficile toxin positive cases were identified using the laboratory data between 01.01.12 and 31.12.13. Notes were reviewed and data collected using a proforma against the hospital guideline. The guideline also states that all positive cases should have a MDT review.

Results 26 C. difficile toxin positive cases were identified from 17 patients. Mean age was 6yrs 5 months, with 92% >24 months at time of diagnosis. 21 were included in the final analysis as medical notes weren’t available for 5 patients.

Risk factors

47% had documentation of recent/current course of antibiotics.

32% of cases identified had previous c difficile toxin positive samples.

7 positive results were from oncology patients

Management

  • 58% (12/21) were treated with antibiotics for what were considered clinically significant infections

  • There was 100% compliance with the guidelines regarding antibiotic choice (metronidazole first line, vancomycin second line).

  • 41% (5/12) cases were treated for the recommended 10 day duration. 16% (2/12) patients received antibiotics for 14 days. 33% (4/12) had variable treatment duration ranging between 1–7 days.

  • There was no documented review of medication for those on either PPI or laxatives and of those on antibiotics only 43% had documentation of review with the result of the c. difficile test.

MDT outcome vs Treated cases

  • 66% (8/12) ‘not confirmed’ (3 had complete course in spite of MDT review; 1 discontinued after review; 1 patient died due to underlying co-morbidities; 3 did not receive antibiotics)

  • 33% (4/12) ‘confirmed’ (all treated with full course of antibiotics)

Repeat stool samples were requested in 26% within 4 weeks of the positive result.

Conclusion C. Difficile testing presents a challenge for paediatricians. The guidelines are mainly adult focussed. More than half of our positive patients didn’t need treatment. The audit highlights the importance of appropriate sampling and the vital role of multidisciplinary team (paediatricians, microbiologists and infection prevention team) in managing these patients.

Recommendation A proforma has been designed to help improve the management of these patients.

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