Characteristics of Clostridium difficile colonization in Japanese children

In children, asymptomatic colonization with Clostridium difficile is well known, but its prevalence in Japanese children is not fully understood. The objective of this study was to determine the colonization rate of C. difficile and to identify the risk factors for C. difficile colonization in Japanese children. Single fecal samples were prospectively collected from children hospitalized in Saitama City Hospital between August 1, 2012, and March 31, 2013. Samples were obtained from neonates, at 4-14 days after birth, and from non-neonatal children, principally within 2 days after admission, to determine community-associated colonization. The fecal samples were cultured for C. difficile, and isolated strains were tested for production of Clostridial toxins A/B. In 95 neonates, the colonization rate of C. difficile was 0%. The 251 non-neonatal children were divided into two subgroups, depending on the presence or absence of underlying disease. In the subgroup without underlying disease, the colonization rates of C. difficile and toxin-positive C. difficile were 21.6% and 9.0%, respectively, while in the subgroup with underlying disease, values were 30.8% and 23.1%, respectively. The proportion of toxin-positive C. difficile in all of the culture-isolated strains from the latter subgroup (75.0%) was statistically higher than that from the former subgroup (41.9%) (P = 0.049). Multivariate logistic regression analysis indicated an association of tube feeding with significantly higher colonization rates of C. difficile (Odds Ratio(OR) = 24.28; 95% confidence interval(CI)[4.70-125.34]; P < 0.001) and toxin-positive C. difficile (OR = 8.29; 95%CI[1.87-36.84]; P = 0.005). Further evaluations are recommended to assess the epidemiology and the role of C. difficile in Japanese children.