Clostridium difficile: An uncommon presentation of an increasingly common infection

This clinical case describes a healthy 6 year old female presenting to the outpatient clinic with frequent, watery diarrhea after a course of antibiotics prescribed for acute sinusitis. She was subsequently diagnosed with Clostridium difficile Infection (CDI). Clostridium difficile Infection is a toxin mediated diarrheal illness typically presenting in adults during or within a few weeks of antibiotic use or a hospital stay. Antimicrobials perpetuating infection include Clindamycin, Cephalosporins, and other broad spectrum antibiotics. Primary treatment regimens includes oral Metronidazole for mild cases, or intravenous or oral Vancomycin for cases of increasing severity. Patients initially present with copious, frequent, watery diarrhea. The sequellae of the disease can range from resolution of mild diarrhea to pseudomembranous colitis, toxic mega colon, sepsis and death. Clostridium difficile Infection rarely affects the pediatric population. The incidence in the pediatric population is estimated at 24.2/100,000 cases per year. However, Clostridium difficile Infection has demonstrated an increasing incidence in this population over the past decade -rising from 7.24 to 12.80 cases per 10,000 discharges. Antibiotic use within the past 12 weeks and the North American pulsed-field electrophoresis type 1 strain (NAP1), are associated with more severe outcomes in children. In the past decade, broad-spectrum antibiotic use has increased, with prescriptions increasing from 223 to 400 (per 1000 persons). This clinical presentation illustrates the importance of identification of increased antibiotic use, antibiotic resistance, as well as antibiotic associated illnesses in children. Programs that target decreasing antibiotic usage can make a significant impact on antibiotic resistance and antibiotic associated illness.