Gaps in Diagnostic and Therapeutic Options for Clostridioides difficile in Immunocompromised Children in Latin America: A PRINCIPAL network perspective

Abstract

Clostridioides difficile infection (CDI) is a major cause of healthcare-associated diarrhea, particularly in immunocompromised children. Advances such as multi-step diagnostic algorithms, the introduction of fidaxomicin, and the use of fecal microbiota transplantation for recurrent episodes have improved outcomes in these patients. However, access to these diagnostic and therapeutic tools remains limited across Latin America. We aimed to assess CDI-related resources and practices across Latin America tertiary hospitals that care for children with cancer and other immunosuppressive conditions and identify existing gaps in diagnosis and management. We conducted a survey among members of the Pediatric Cancer Infection Preventionists and Infectious Diseases Specialists Network in Latin America (PRINCIPAL). The survey assessed the availability of diagnostic tools (including enzyme immunoassays and nucleic acid amplification tests) and therapeutic options (metronidazole, vancomycin, fidaxomicin, fecal microbiota transplantation. We then compared current international recommendations for CDI diagnosis and treatment with their reported availability in tertiary hospitals in Latin America that treat children with cancer and other immunosuppressive conditions. Thirty-six members of the PRINCIPAL Network from 30 tertiary institutions completed the survey. Diagnostic techniques available included glutamate dehydrogenase (GDH) antigen testing in 47.2% of centers, A/B toxin immunoassays in 69.4%, and nucleic acid amplification tests (NAAT) in 91.7%. Therapeutically, metronidazole and vancomycin were available in 97.2% and 91.7% of hospitals, respectively. No institution reported access to fidaxomicin, and fecal microbiota transplantation for recurrent CDI had not been performed in any center. Significant gaps exist in both diagnostic and therapeutic possibilities for CDI in Latin America for immunocompromised children. Despite international advances in diagnostics and treatment, implementation of these innovations remains limited across Latin American centers. Closing these gaps will require strengthening laboratory capacity, improving access to advanced diagnostics, and expanding therapeutic options.