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Incidence of Clostridium difficile in hospitalized children. A prospective study
M Tvede1, P O Schiøtz, P A Krasilnikoff
1Department of Clinical Microbiology, Rigshospitalet, Denmark.
Insights
Clostridium difficile (C. diff) occurs in 24% of children with gastrointestinal issues or prior antibiotic use. This common bacterial infection is often community-acquired, particularly in infants.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Clostridium difficile is an opportunistic pathogen.
- Antibiotic use and gastrointestinal diseases are risk factors for C. diff infection.
- Understanding C. diff prevalence in children is crucial for effective management.
Purpose of the Study:
- To investigate the occurrence and clinical significance of Clostridium difficile in pediatric patients.
- To determine the prevalence of C. diff and its cytotoxin in fecal samples of children.
- To identify risk factors associated with C. diff colonization in this age group.
Main Methods:
- Prospective study over one year involving 394 children aged 0-14 years referred to a pediatric department.
- Investigation included testing for Clostridium difficile and its cytotoxin in fecal samples.
- Comparison between children with gastrointestinal diseases/prior antibiotic treatment and healthy controls.
Main Results:
- Clostridium difficile was detected in 24% of children with gastrointestinal diseases or prior antibiotic treatment.
- Cytotoxin was present in half of the C. diff positive cases.
- C. diff was the sole pathogen in 12% of acute gastroenteritis cases and significantly more prevalent in infants under one year old.
Conclusions:
- Clostridium difficile is a significant pathogen in pediatric patients, especially those with gastrointestinal issues or recent antibiotic exposure.
- The majority of C. diff cases in hospitalized children appear to be community-acquired.
- Infants under one year represent a high-risk group for C. diff colonization.
Abstract:
A total of 394 children, aged 0-14 years, referred to a paediatric department were investigated for the occurrence of Clostridium difficile, its cytotoxin in faeces, and its clinical significance in a prospective study over one year. Of the children in the investigation, 337 suffered from gastrointestinal diseases or had been treated with antibiotics prior to the investigation. Twenty-four percent of these children had Cl. difficile in one or more faecal samples and toxin was demonstrated in half of these patients. In 18/148 (12%) of the patients with acute gastroenteritis Cl. difficile was isolated as the only pathogen. In contrast, among 57 control children with no gastrointestinal symptoms and no prior antibiotic treatment significantly fewer harboured Cl. difficile (p less than 0.01). Cl. difficile was isolated with similar frequency in children with or without prior antibiotic treatment. Isolation of Cl. difficile was significantly higher in patients under one year of age (p less than 0.001). In 78% of the patients with Cl. difficile the bacteria were found in faeces during the initial two days of hospitalization indicating that most of the cases were community acquired. The occurrence of Cl. difficile was not influenced by seasonal variation and the distribution between sexes was equal.