A 10-year-old female with spina bifida and neurogenic bowel was hospitalized for abdominal pain, dehydration, and more than 20 episodes of watery diarrhea per day. Her symptoms began 5 days after completing a course of amoxicillin for streptococcal pharyngitis. Results of a gastrointestinal pathogen panel that included 18 bacterial, viral, and parasitic pathogens were negative. A stool sample result was positive for Clostridioides difficile by polymerase chain reaction (PCR) testing and an enzyme immunoassay test for C difficile toxin A and B had a negative result.
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B. Antibiotic treatment for C difficile infection is warranted.
Few studies are available to guide best testing practices for the diagnosis of C difficile infection (CDI) in children.1 Colonization with toxigenic and nontoxigenic C difficile affects 3% to 40% of children younger than 3 years and 3% to 26% of hospitalized children and adults.2 Therefore, diarrhea from causes other than CDI, such as laxatives, viral infections, and prior antibiotic use, should be considered.3
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Corresponding Author: Maribeth R. Nicholson, MD, MPH, Monroe Carell Jr Children’s Hospital at Vanderbilt, 2200 Children’s Way, Nashville, TN 37232 (email@example.com).
Published Online: August 21, 2023. doi:10.1001/jama.2023.15875
Conflict of Interest Disclosures: Dr Nicholson reported being supported by a National Institute of Allergy and Infectious Diseases K23 award (No.1K23AI156132-01). Dr Donskey reported grants to his institution from Pfizer, Clorox, and Ecolab outside the submitted work. No other disclosures were reported.
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