In the JournalsPerspective

Guidelines recommend against routine testing for C. difficile in infants

Photo of Thomas Sandora
Thomas Sandora

The Society for Healthcare Epidemiology of America has released new guidelines for detecting and preventing Clostridioides difficile also known as Clostridium difficile — in a neonatal ICU setting.

“Few data exist to guide frontline clinicians about prevention of C. difficile in this vulnerable population,” Thomas Sandora, MD, MPH, pediatric infectious diseases physician at Boston Children’s Hospital, said in a press release. “This white paper is the first of a planned series of reports that will synthesize the latest and best research in infection prevention to ensure we are providing care based on the most current information and expert opinion.”

Published in Infection Control & Hospital Epidemiology, the SHEA White Paper was released in conjunction with a companion review by the CDC’s Healthcare Infection Control Practices Advisory Committee, according to the release.

In it, the authors recommend against routine testing for C. difficile in neonatal ICU (NICU) patients, suggesting that the children should be tested for more common causes of diarrhea.

Routine testing is not recommended in NICU patients “because of the high prevalence of asymptomatic carriage of toxicogenic C. difficile in infants aged less than 12 months,” the authors wrote.

The authors added that when C. difficile is detected in the stool of an infant, it may not be possible to determine with certainty that the test result represents C. difficile infection (CDI). Patients should be tested for CDI if there is evidence of pseudomembranous colitis or there if the child has significant diarrhea and other causes of diarrhea have been excluded, according to the guidelines.

Noninfectious causes of diarrhea should first be investigated, the authors wrote. They added that the stool should be tested for norovirus, rotavirus, adenovirus and enterovirus. Bacterial stool culture testing is recommended for infants admitted to the NICU from the community or those who have possibly been exposed to bacterial enteritis.

The authors also posted guidelines on the best methods for treating CDI in patients in the NICU and the preferred hand hygiene regimen for managing NICU patients who test positive for CDI in a nonoutbreak setting. This includes using soap and water over alcohol-based hand rub for room entry and exit.

The guidelines also included the appropriate type of isolation and duration of isolation for an infant with a positive C. difficile test and the appropriate cleaning and disinfection strategy for C. difficile in the NICU.

Regarding the role of antimicrobial stewardship in preventing C. difficile in infants, the authors wrote that it “has resulted in decreases in CDI in many populations, and because of its beneficial impact on other adverse events seen in the NICU, encouraging appropriate use of antimicrobials should be a priority.”

Disclosures: See the guidelines for a complete list of the authors’ relevant financial disclosures.

Photo of Thomas Sandora
Thomas Sandora

The Society for Healthcare Epidemiology of America has released new guidelines for detecting and preventing Clostridioides difficile also known as Clostridium difficile — in a neonatal ICU setting.

“Few data exist to guide frontline clinicians about prevention of C. difficile in this vulnerable population,” Thomas Sandora, MD, MPH, pediatric infectious diseases physician at Boston Children’s Hospital, said in a press release. “This white paper is the first of a planned series of reports that will synthesize the latest and best research in infection prevention to ensure we are providing care based on the most current information and expert opinion.”

Published in Infection Control & Hospital Epidemiology, the SHEA White Paper was released in conjunction with a companion review by the CDC’s Healthcare Infection Control Practices Advisory Committee, according to the release.

In it, the authors recommend against routine testing for C. difficile in neonatal ICU (NICU) patients, suggesting that the children should be tested for more common causes of diarrhea.

Routine testing is not recommended in NICU patients “because of the high prevalence of asymptomatic carriage of toxicogenic C. difficile in infants aged less than 12 months,” the authors wrote.

The authors added that when C. difficile is detected in the stool of an infant, it may not be possible to determine with certainty that the test result represents C. difficile infection (CDI). Patients should be tested for CDI if there is evidence of pseudomembranous colitis or there if the child has significant diarrhea and other causes of diarrhea have been excluded, according to the guidelines.

Noninfectious causes of diarrhea should first be investigated, the authors wrote. They added that the stool should be tested for norovirus, rotavirus, adenovirus and enterovirus. Bacterial stool culture testing is recommended for infants admitted to the NICU from the community or those who have possibly been exposed to bacterial enteritis.

The authors also posted guidelines on the best methods for treating CDI in patients in the NICU and the preferred hand hygiene regimen for managing NICU patients who test positive for CDI in a nonoutbreak setting. This includes using soap and water over alcohol-based hand rub for room entry and exit.

The guidelines also included the appropriate type of isolation and duration of isolation for an infant with a positive C. difficile test and the appropriate cleaning and disinfection strategy for C. difficile in the NICU.

Regarding the role of antimicrobial stewardship in preventing C. difficile in infants, the authors wrote that it “has resulted in decreases in CDI in many populations, and because of its beneficial impact on other adverse events seen in the NICU, encouraging appropriate use of antimicrobials should be a priority.”

Disclosures: See the guidelines for a complete list of the authors’ relevant financial disclosures.

    Perspective
    Keith S. Kaye

    Keith S. Kaye

    SHEA’s white paper helps to fill in the gaps that clinicians have in preventing C. difficile infection in the NICU. Because of the unique factors in the digestive systems of infants, diagnosis and prevention of this common infection can be challenging. This white paper provides useful advice for clinicians recommending against routine testing for C. difficile and suggests to first evaluate for more common causes of diarrhea.

    SHEA believes that this white paper is important and will help to standardize practice and avoid misdiagnosis and unnecessary antibiotic use.

    • Keith S. Kaye, MD, MPH
    • President of SHEA

    Disclosures: Kaye reports no relevant financial disclosures.