Severity assessment of C. difficile infection in children

In children, complicated C. difficile infection is uncommon, and severity criteria used in adults are generally not applicable. Nevertheless, complicated C. difficile infection should be considered as a potential diagnosis in high-risk children (especially those with malignancy or chronic gastrointestinal disorders). Complications of C. difficile infection include sepsis or septic shock, ileus, perforated viscus and toxic megacolon. In children receiving cancer treatments and haematopoietic cell transplantation, complicated C. difficile is defined as the presence of colitis, pneumatosis intestinalis, pseudomembranous colitis, ileus or surgery for C. difficile infectionHaeusler, 2022.

The definition of severe C. difficile infection in children is not well established – use clinical judgement when assessing severity. Severity scoring tools that include multiple of the following criteria have been proposedPai, 2012:

• diarrhoea more than 5 times per day
• abdominal pain and discomfort
• rising white cell count
• raised C-reactive protein
• fever (38°C or higher)
• evidence of pseudomembranous colitis
• intensive care unit requirement.

Rapidly progressing severe disease is known as fulminant disease, which is life threatening and requires urgent intervention.

Children without severe, complicated or fulminant disease are considered to have mild to moderate disease.