Clostridioides difficile infections in children with cancer A single-center observational study.

Abstract

Introduction: Clostridioides difficile is a common cause of nosocomial diarrhea, but little is known about its evolution in neutropenic patients with hematological cancers. This is a prospective study on the behavior and complications of diarrhea caused by Clostridioides difficile in neutropenic children being treated for cancer, especially hematological cancers.

Methodology: A prospective observational study was conducted in the pediatric oncology service of the National Oncology Institute, SOLCA (Guayaquil, Ecuador), from April 2024 to March 2025. The estimated sample size was 25 pediatric patients admitted for neutropenia secondary to chemotherapy for hematological cancers or solid tumors. Data on age, sex, neoplasm type, antibiotic use, clinical features, and treatment were collected directly from institutional medical records, and PCR confirmed the diagnosis of Clostridioides difficile infection in gastrointestinal panels.

Results: A total of 25 pediatric patients (16 females, 9 males) with chemotherapy-induced neutropenia, mainly due to lymphocytic leukemia (20 cases), were analyzed. The average day of Clostridioides difficile detection was 19 days after the start of neutropenia. Most patients (21) had recent antibiotic use, primarily cefepime and meropenem, and nine used proton pump inhibitors. Diarrhea lasted between 1 and 5 days in 15 patients and was liquid, with macroscopic blood in 32% and mucus in 48%. Sixty percent of the children were afebrile, and 36% showed ultrasound abnormalities, such as colon thickening (range 3.1-6.5 mm), progressing to colitis in nine cases, four of which required CT scans. Three patients had concomitant bacteremia (E. coli ESBL, Candida parapsilosis, and Klebsiella pneumoniae). Seven children (28%) experienced recurrences, mainly managed with metronidazole, which resulted in resolution in all 25 patients, with no deaths or need for surgical intervention.

Conclusion: Although the disease poses a risk of colitis and concomitant bacteremia, treatment with metronidazole was reliably effective for clinical resolution in all patients. Despite a significant recurrence rate (28%), no fatal outcomes or surgical interventions were recorded, indicating that, with proper surveillance, C. difficile infection in this population, while potentially complicated, has a favorable short-term prognosis.