Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.
Harvard Medical School, Boston, Massachusetts, United States.
Infect Control Hosp Epidemiol. 2023 Sep;44(9):1403-1409. doi: 10.1017/ice.2022.310. Epub 2023 Jan 10.
In adults with infection (CDI), higher stool concentrations of toxins A and B are associated with severe baseline disease, CDI-attributable severe outcomes, and recurrence. We evaluated whether toxin concentration predicts these presentations in children with CDI.
We conducted a prospective cohort study of inpatients aged 2-17 years with CDI who received treatment. Patients were followed for 40 days after diagnosis for severe outcomes (intensive care unit admission, colectomy, or death, categorized as CDI primarily attributable, CDI contributed, or CDI not contributing) and recurrence. Baseline stool toxin A and B concentrations were measured using ultrasensitive single-molecule array assay, and 12 plasma cytokines were measured when blood was available.
We enrolled 187 pediatric patients (median age, 9.6 years). Patients with severe baseline disease by IDSA-SHEA criteria (n = 34) had nonsignificantly higher median stool toxin A+B concentration than those without severe disease (n = 122; 3,217.2 vs 473.3 pg/mL; = .08). Median toxin A+B concentration was nonsignificantly higher in children with a primarily attributed severe outcome (n = 4) versus no severe outcome (n = 148; 19,472.6 vs 429.1 pg/mL; = .301). Recurrence occurred in 17 (9.4%) of 180 patients. Baseline toxin A+B concentration was significantly higher in patients with versus without recurrence: 4,398.8 versus 280.8 pg/mL ( = .024). Plasma granulocyte colony-stimulating factor concentration was significantly higher in CDI patients versus non-CDI diarrhea controls: 165.5 versus 28.5 pg/mL ( < .001).
Higher baseline stool toxin concentrations are present in children with CDI recurrence. Toxin quantification should be included in CDI treatment trials to evaluate its use in severity assessment and outcome prediction.
在成人感染（CDI）中，粪便中 A 型和 B 型毒素的浓度较高与严重的基线疾病、与 CDI 相关的严重结局以及复发有关。我们评估了在患有 CDI 的儿童中，毒素浓度是否可以预测这些表现。
我们对接受治疗的患有 CDI 的住院 2-17 岁儿童进行了前瞻性队列研究。在诊断后 40 天内，对严重结局（重症监护病房收治、结肠切除术或死亡，分为 CDI 主要归因、CDI 促成或 CDI 不促成）和复发情况进行随访。使用超灵敏单分子阵列测定法检测基线粪便毒素 A 和 B 的浓度，当有血液样本时，检测 12 种血浆细胞因子。
我们共纳入 187 名儿科患者（中位年龄为 9.6 岁）。根据 IDSA-SHEA 标准，基线疾病严重的患者（n = 34）粪便毒素 A+B 的中位数浓度显著高于无严重疾病的患者（n = 122；3217.2 vs 473.3 pg/mL； =.08）。与无严重结局（n = 148）相比，主要归因于严重结局的患儿（n = 4）的毒素 A+B 浓度中位数显著升高（19472.6 vs 429.1 pg/mL； =.301）。在 180 例患者中有 17 例（9.4%）复发。与无复发的患者相比，有复发的患者的基线毒素 A+B 浓度显著升高：4398.8 vs 280.8 pg/mL（ =.024）。与非 CDI 腹泻对照组相比，CDI 患者的血浆粒细胞集落刺激因子浓度显著升高：165.5 vs 28.5 pg/mL（ <.001）。
在患有 CDI 复发的儿童中，粪便中存在更高的基线毒素浓度。在 CDI 治疗试验中，应包括毒素定量检测，以评估其在严重程度评估和结局预测中的作用。
