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Updated: Apr 24, 2026
Culturing and Maintaining Clostridium difficile in an Anaerobic Environment
Published on: September 14, 2013
[Clostridium difficile isolation in children hospitalized with diarrhea]
B Santiago1, L Guerra2, M García-Morín2
1Laboratorio de InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, España; Sección de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
Insights
Clostridium difficile infection (CDI) is common in hospitalized children with diarrhea, particularly in those under two years old. Comorbidity and healthcare contact are key risk factors for CDI in this population.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Hospital Epidemiology
Background:
- Clostridium difficile is a major cause of hospital-acquired diarrhea in adults.
- Assessing Clostridium difficile infection (CDI) prevalence in children is challenging due to high colonization rates.
Purpose of the Study:
- To determine the incidence and characteristics of Clostridium difficile infection (CDI) in hospitalized children with acute diarrhea.
- To identify risk factors and compare clinical outcomes of CDI in children versus other causes of diarrhea.
Main Methods:
- A one-year retrospective study of children under 15 with acute diarrhea.
- Comparison of epidemiological, clinical, and laboratory findings between CDI cases and non-CDI cases.
- Multivariate analysis to identify risk factors for CDI.
Main Results:
- Clostridium difficile infection (CDI) was identified in 19 of 174 tested children (10.9%), with an estimated incidence of 3 cases/1,000 admissions.
- CDI was more common in children under 2 years (68.4%) and associated with comorbidity, recent healthcare contact, and prior antibiotic use.
- Children with CDI had a less symptomatic clinical course compared to other diarrhea causes.
Conclusions:
- Clostridium difficile is frequently isolated from hospitalized children with diarrhea.
- Comorbidity and recent healthcare exposure are significant risk factors for CDI in pediatric patients.
- Further research is needed to clarify the epidemiology of pediatric CDI, including asymptomatic carriage.
Introduction:
Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting.
Material And Methods:
A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis.
Results:
Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001).
Conclusions:
The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers.
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