Table 2.

Comparison of CDI Characteristics among Adult versus Pediatric Patients

CDI Characteristic	Adult	Children	Reference
Epidemiology
C. difficile colonization	Uncommon	Frequent among infants	Al-Jumaili et al., 1984; Loo et al., 2005
Community-acquired CDI	Increasing prevalence	Increasing prevalence	Benson et al., 2007; Khanna et al., 2012
BI/NAP1/027 strain prevalence	~20% of isolates	~20% of isolates	Toltzis et al., 2009; Wilcox et al., 2012
Pathogenesis	Toxin-mediated	Poorly understood; frequent asymptomatic carriage hypothesized to be related to intestinal microbiome composition or lack of toxin receptors	Kleesen et al., 1995; Eglow et al., 1992; Voth and Ballard, 2005
Host genetic susceptibility	Possible role for IL-8 gene SNP	Unknown	Garey et al., 2010
Host immunity	Possible protection with antibodies against toxins A and B	Not well studied	Kyne et al., 2000; Leung et al., 1991; Lowy et al., 2010
Risk factors	Older age, antibiotic and healthcare exposure, significant co-morbidities	Antibiotic and healthcare exposure, significant co-morbidities; protection with breast feeding	Sandora et al., 2011; Kyne et al., 2002
Transmission	Fecal-oral	Possible reservoir of colonized infants	Rousseau et al., 2011; Wilcox et al., 2008
Clinical manifestations	Bloody diarrhea rare; recurrence in ~25% patients	Bloody diarrhea relatively common; recurrence in ~25% patients	Morinville and McDonald, 2005; Mogg et al., 1979
Treatment	Mild-moderate: Metronidazole Severe: Vancomycin	No well-designed clinical trials to guide treatment recommendations	Zar et al., 2007
Prevention	Monoclonal antibodies, vaccines, probiotics currently in development	No well-designed clinical trials conducted	Lowy et al., 2010; Foglia et al., 2012; McFarland et al., 1994