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Recurrent community-acquired Clostridium(Clostridioides)difficile infection in Serbianchildren
Stojanovic Predrag1,2, Ed J Kuijper3, Stojanović Nikola4
1Faculty of Medicine, University of Niš, Zorana Đinđića 50, Niš, 18000, Serbia. pedjamicro@sezampro.rs.
Insights
Recurrent community-acquired Clostridium difficile infections (rCA-CDI) in children are linked to underlying leukemia, immunosuppressive therapy, and prior hospital visits. Severe initial infections and specific ribotypes increase rCA-CDI risk in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Recurrent Clostridium difficile infections (rCDI) are uncommon in children, particularly community-acquired cases (CA-CDI).
- Limited data exists on risk factors for rCA-CDI in pediatric populations.
- Understanding these factors is crucial for prevention and management strategies.
Purpose of the Study:
- To identify risk factors associated with recurrent community-acquired Clostridium difficile infections (rCA-CDI) in a Serbian pediatric cohort.
- To analyze clinical, laboratory, and microbiological parameters correlating with rCA-CDI development.
- To establish a baseline for future predictive modeling of rCDI in children.
Main Methods:
- A case-control study involving 71 children (1-14 years) with a first episode of CDI.
- Comparison of demographic, clinical, and treatment data between children with single CDI episodes and those with rCA-CDI.
- Analysis of underlying diseases, medication history, healthcare exposure, clinical symptoms, laboratory markers (WBC, CRP), and Clostridium difficile ribotypes.
Main Results:
- The rate of rCA-CDI was 21.13% over a seven-year period.
- Leukemia, immunosuppressive/cytostatic drugs, prior antibiotic use, and previous healthcare visits were significant risk factors for rCA-CDI.
- Severe initial CDI episodes (fever, elevated WBC, CRP) and the presence of Clostridium difficile ribotype 027 were associated with recurrence.
Conclusions:
- Several key parameters significantly increase the risk of rCA-CDI in children.
- These findings highlight the need for targeted monitoring and preventive measures in high-risk pediatric patients.
- Further prospective studies are essential to develop robust prediction models for rCDI in children.
Abstract:
Information on recurrent Clostridium difficile infections (rCDI) in children is rare and limited, especially community acquired (CA-CDI).This study was designed to identify risk factors for rCA-CDI in Serbian pediatric population. The study group included 71 children (aged from 1 to 14 years) with a first episode of CDI. Data were collected from 56 (78.87%) children with only one episode of CA-CDI and from 15 (21.13%) children with rCA-CDI were mutually compared. The following parameters were found to be statistically significantly more frequent in the children with rCA-CDI group (p < 0.05); leukemia as underlying disease, treatment with immunosuppressive and-or cytostatic drugs, and treatment with antibiotics. Similarly, previously visits to outpatient facilities, daycare hospitals and hospitals were also associated with rCDI. Analysis of clinical symptoms and laboratory parameters, revealed a statistically significant association of the severity of the first episode of CDI (determined by an increase in body temperature, higher maximum WBC and higher CRP) with development of a rCDI. Ribotype (RT) 027 was more common in children with rCA-CDI (66.7%, p = 0.006). During the seven-year research period, we found a rate of rCA-CDI rate in children of 21.13%. Our study identified several parameters statistically significantly more frequently in children with rCA-CDI. The obtained results will serve as a basis for future larger studies, but new prospective, studies are necessary to build a prediction model of rCDI in children that can be used to guide the treatment to prevent rCDI.
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