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Updated: Feb 4, 2026
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Increased age and proton pump inhibitors are associated with severe Clostridium difficile infections in children
Tu-Hsuan Chang1, Wei-Yun Hsu2, Tzu-I Yang3
1Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Clostridium difficile infection (CDI) in children presents with specific symptoms like watery diarrhea and occult blood. Older age and proton pump inhibitor use are key risk factors for severe CDI outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Clostridium difficile infection (CDI) incidence is rising among pediatric populations.
- Distinguishing CDI from asymptomatic colonization is crucial for appropriate management.
- Identifying risk factors for severe CDI in children is essential for early intervention.
Purpose of the Study:
- To compare clinical characteristics differentiating CDI from C. difficile colonization in children.
- To identify independent risk factors associated with severe CDI outcomes in pediatric patients.
Main Methods:
- Retrospective review of 124 pediatric patients (1-18 years) diagnosed with C. difficile between 2011-2018.
- CDI defined by diarrhea and confirmed toxigenic strain; colonization by C. difficile presence without symptoms.
- Exclusion criteria included infants <1 year and coinfections; severe disease defined by ileus, AKI, GI bleeding, or mortality.
Main Results:
- 49 patients had CDI, 75 had colonization. CDI cases showed significantly higher rates of watery stool, mucoid stool, and occult blood.
- CDI patients exhibited higher rates of elevated creatinine and hyponatremia, with more complicated disease presentations.
- Multivariate analysis identified age >4 years (aOR: 5.83) and proton pump inhibitor (PPI) use (aOR: 7.25) as independent risk factors for severe CDI.
Conclusions:
- Watery diarrhea, mucoid stool, and occult blood are reliable indicators differentiating pediatric CDI from colonization.
- Increased age and prior proton pump inhibitor (PPI) use are significant independent risk factors for severe disease in children with CDI.
Background:
Clostridium difficile infection (CDI) is increasing in children. We aimed to compare the clinical characteristics between CDI and colonization and to identify the risk factors for severe diseases of CDI in children.
Method:
We retrospectively reviewed 124 children (1-18 years old) from 2011 to 2018. CDI was defined as diarrhea (≥3 loose stool in the past 24 h) with confirmed toxigenic strain. Colonization was defined as presence of C. difficile without clinical symptoms. Severe diseases included ileus, acute kidney injury, gastrointestinal bleeding or mortality. Patients younger than 1 year old and coinfections with other enteric pathogens were excluded.
Results:
Among 124 patients with C. difficile identified, 49 of them fulfilled CDI definition and 75 had C. difficile colonization. Children with CDI were more likely to present with watery (74% vs. 1%, p < 0.01) and mucoid stool (25% vs. 7%, p < 0.01) and occult blood in stool (67% vs. 33%, p < 0.01) than children with colonization. In CDI cases, elevated age-adjusted creatinine (18% vs. 0%, p = 0.03) and hyponatremia (134 mEq/L vs. 137 mEq/L, p = 0.04) were found. Also, they had more complicated diseases (27% vs. 0%, p < 0.01). On multivariate analysis, age older than 4 years (adjusted odds ratio: 5.83; 95% confidence interval: 1.05-32.27) and proton pump inhibitor use (PPI) (adjusted odds ratio: 7.25; 95% confidence interval: 1.07-49.07) were the independent factors for severe diseases.
Conclusions:
Watery diarrhea, mucoid stool and occult blood in stool could differentiate CDI from colonization. Patients with increased age and previous PPI use were the independent risk factors for severe diseases in children.
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