INVESTIGATION AND MANAGEMENT OF CLOSTRIDIUM-DIFFICILE COLONIZATION INA PEDIATRIC ONCOLOGY UNIT

Little is known about Clostridium difficile infection in children with cancer but a presumed outbreak has previously been described. The car riage rate before admission to hospital and morbidity is reported to b e high, especially in younger children. The prevalence of C difficile infection on a paediatric oncology ward was monitored from June 1991 t o May 1992. Twenty eight (13%) of 214 children were found to be infect ed. Though the temporal distribution suggested an outbreak, polyacryla mide gel electrophoresis identified several different types. Unlike pr evious reports, infection appeared to be possibly endogenous or possib ly environmental in origin rather than due to cross infection; the mor bidity was low and age was not a determinant for infection. The durati on of hospital stay and the primary diagnosis were found to be determi nants for infections, those with lymphoid malignancies being at the hi ghest risk. The diagnostic category at greatest risk were those most i ntensively treated, with protracted neutropenia and prolonged antibiot ic exposure. Early identification of cases and prompt institution of s imple control measures will prevent cross infection. It is therefore i mportant that diarrhoea is not accepted as a normal symptom of cancer chemotherapy and stool specimens are sent for full bacteriological and viral investigation.