Clostridioides difficile Infection in Children: The Role of Infection Prevention and Antimicrobial Stewardship

Abstract There are 2 primary approaches to prevent Clostridioides difficile infection (CDI) in children: prevent transmission and acquisition of the organism and prevent the progression from colonization to disease. The most important interventions to reduce the risk of transmission include contact precautions, hand hygiene, and environmental disinfection. Glove use minimizes contamination of the hands by spores and is associated with reductions in CDI incidence. Hand hygiene with soap and water and disinfection with a sporicidal agent are recommended as the best approaches in hyperendemic settings. Because antibiotic exposure is the most important modifiable risk factor for CDI, antimicrobial stewardship focused on identified high-risk antibiotic classes (including clindamycin, fluoroquinolones, and third- and fourth-generation cephalosporins) is critical to preventing progression from colonization to infection. Despite clear evidence that antimicrobial stewardship programs (ASPs) are associated with reduced CDI rates in adults, data demonstrating the ASP impact on pediatric CDI are lacking. The core interventions to prevent Clostridioides difficile infection (CDI) include contact precautions, hand hygiene, environmental disinfection, and antimicrobial stewardship. Despite evidence linking antibiotic use with CDI, research is needed to demonstrate the impact of antimicrobial stewardship programs on pediatric CDI.