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Occurrence and significance of Clostridium difficile in faecal specimens of hospitalized children
W Karsch1, E Strelau, W D Grahlow
1Institut für Infektionskrankheiten im Kindesalter im Klinikum Berlin-Buch, DDR.
Insights
Clostridioides difficile (C. difficile) is common in infants, with isolation rates decreasing with age. This study found no significant difference in C. difficile presence or toxin production between children with and without diarrhea.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Clostridioides difficile (C. difficile) is a significant cause of antibiotic-associated diarrhea.
- Understanding the prevalence and toxin production of C. difficile in hospitalized children is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate the prevalence of C. difficile in hospitalized children with and without diarrhea.
- To assess the toxin A and B production of C. difficile strains isolated from children.
- To determine the influence of age and prior antibiotic therapy on C. difficile isolation.
Main Methods:
- Stool specimens were collected from 766 hospitalized children (418 with diarrhea, 348 controls).
- C. difficile isolation and identification were performed.
- Toxin A and B production were measured using cell culture and rabbit ileal loop tests.
- In vivo toxin B production was assessed in stool specimens.
Main Results:
- C. difficile isolation was highest (approx. 30%) in infants under one year old, decreasing to 5% in older children.
- No significant difference in C. difficile frequency was observed between children with diarrhea and controls.
- Previous antibiotic therapy did not significantly influence isolation rates.
- 82.2% of strains produced toxin B and 43% produced toxin A, with no significant difference in toxin production between groups.
Conclusions:
- C. difficile colonization is common in young children, irrespective of diarrhea status.
- Toxin production by C. difficile strains in children does not correlate with the presence of diarrhea.
- Age is a significant factor in C. difficile isolation rates, with younger children showing higher prevalence.
Abstract:
Stool specimens from 766 hospitalized children, 418 with diarrhoea and 348 controls, were investigated for C. difficile. In both groups the rate of isolation was highest (about 30%) during the first year of life, dropping to nearly 5% in older children. There was no significant difference in the frequency of C. difficile in children with diarrhoea and the controls nor was there a significant influence of previous antibiotic therapy on the rate of isolation. 111/135 strains (82.2%) produced toxin B and 58/135 strains (43%) produced toxin A measured by Y-1- cell culture (toxin B) and rabbit ileal loop test (toxin A). We did not find any significant difference in the toxin production between strains isolated from diarrhoeal children and from the controls. A total of 285 stool specimens was investigated for toxin B production in vivo. There was no significant difference of toxin B in the stool specimens of both groups.