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Updated: May 4, 2026
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Predictors of Clostridium difficile infections in hospitalized children
Insights
Pediatric Clostridium difficile infections (CDIs) are rising, often occurring in children without typical risk factors. Immunodeficiency is the strongest clinical predictor, highlighting the need for broader diagnostic consideration in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Increasing incidence of Clostridium difficile infections (CDIs) reported in children.
- CDIs may occur in pediatric populations beyond those traditionally considered at risk.
Purpose of the Study:
- Identify clinical factors associated with CDI in hospitalized children.
- Differentiate CDI cases from controls with similar diarrheal illness.
Main Methods:
- Retrospective case-control study design.
- Involved 134 pediatric Clostridium difficile (CD) cases and 274 age-matched controls (CTLs).
- Evaluated clinical data including symptoms, medical history, and medication use.
Main Results:
- Immunodeficiency (46% vs 6%), gastrointestinal disease (31% vs 18%), and proton pump inhibitor (PPI) use (22% vs 7%) were significantly more frequent in CD cases.
- Antibiotic use (OR: 2.80), recent hospitalization (OR: 2.33), and immunodeficiency (OR: 6.02) were key independent predictors of CDI.
- 30% of CDIs were community-acquired, with bloody diarrhea being more common in this subgroup.
Conclusions:
- Clinical history, particularly immunodeficiency, is more valuable than symptoms for distinguishing pediatric CDI.
- A significant percentage of pediatric CDIs occurred in patients lacking traditional risk factors.
- Findings support concerns about CDIs emerging in lower-risk pediatric populations.
Background:
Recent studies report an increasing incidence of Clostridium difficile infections (CDIs) in children and suggest that CDIs may occur outside known populations at risk.
Objective:
To identify clinical factors associated with CDI in a hospitalized pediatric population.
Methods:
A retrospective case-control study was conducted with C difficile cases (CD) and controls (CTLs) in hospitalized children over a 2-year period. CDs (N = 134) and 2:1 age-matched CTLs (N = 274) with diarrheal illness were evaluated.
Results:
CDs and CTLs were similar in gender and race. Watery diarrhea was the most common type of diarrhea in CDs and CTLs. Immunodeficiency (46% vs 6%; P < 0.001), gastrointestinal (GI) disease (31% vs 18%; P = 0.005), and proton pump inhibitor (PPI) use (22% vs 7%; P < 0.001) were more frequent in CDs. Of CDs, 30% were defined as community acquired. Bloody diarrhea was more frequent in community-acquired CD (28% vs 4% P < 0.001); however, other clinical variables were not statistically different. No antibiotic exposure, recent hospitalization, prolonged hospitalization, or past history of CDI existed in 8% of CDs. Multivariate logistic regression demonstrated that antibiotic use (odds ratio [OR]: 2.80, P = 0.001), recent hospitalization (OR: 2.33, P = 0.007), and immunodeficiency (OR: 6.02, P < 0.001) were significantly associated with cases when controlling for PPI use, having GI disease, and history of abdominal surgery.
Conclusions:
Clinical history is of greater value than symptoms in distinguishing CD, with immunodeficiency having the strongest association. An important percentage of CDs did not have any risk factors, confirming concerns that CDIs do occur in otherwise low-risk pediatric populations.
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