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Detection of Clostridioides difficile by Real-time PCR in Young Children Does Not Predict Disease
Barbara A Pahud1, Ferdaus Hassan2, Christopher J Harrison2
1Children's Mercy Hospital Kansas City and University of Missouri, Kansas City, Kansas City, Missouri; bapahud@cmh.edu.
Objectives:
Diagnosing Clostridioides difficile infections in young children with high asymptomatic colonization is challenging. We compared the frequency of C difficile detection by polymerase chain reaction (PCR) in healthy control (HC) children with those with acute gastroenteritis (AGE) and evaluated fecal-lactoferrin and organism load as possible indicators of true C difficile infection disease.
Methods:
Stool was collected from children <2 years old with AGE and from HCs. C difficile was detected by real-time PCR, and lactoferrin was measured by enzyme-linked immunosorbent assay. Clinical data were obtained via interviews and chart review. Mann-Whitney U test and χ2 tests were used for group comparisons.
Results:
Of 524 stools collected from 524 children (250 with AGE, 274 HCs), C difficile was detected less in children with AGE (14%, 36 of 250) than in HCs (28%, 76 of 274) stools (P < .0001). Among infants <1 year old (n = 297), C difficile was detected in 18% of children with AGE versus 32% of HCs (P < .005), and among children 1 to 2 years old (n = 227), C difficile was detected in 10% of children with AGE versus 21% of HCs (P < .02). There was no significant difference in C difficile PCR cycle threshold values between children with AGE and HCs or lactoferrin levels in C difficile PCR-positive versus -negative stools.
Conclusions:
HC children <2 years of age had higher rates of C difficile detection by PCR than children with AGE; C difficile detection by real-time PCR alone is not a reliable means to diagnose C difficile disease in children <2 years old.
Insights
Diagnosing Clostridioides difficile infections in young children is difficult. Polymerase chain reaction (PCR) detected C. difficile more in healthy children than those with acute gastroenteritis, indicating PCR alone is unreliable for diagnosis.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Diagnostic Accuracy
Background:
- Clostridioides difficile infections (CDI) pose diagnostic challenges in young children due to high rates of asymptomatic colonization.
- Differentiating true CDI from colonization is crucial for appropriate treatment and management.
Purpose of the Study:
- To compare the frequency of C. difficile detection via PCR in healthy children versus those with acute gastroenteritis (AGE).
- To evaluate fecal lactoferrin and organism load as potential indicators of true C. difficile disease.
Main Methods:
- Real-time PCR was used to detect C. difficile in stool samples from children under 2 years old with AGE and healthy controls (HCs).
- Fecal lactoferrin levels were measured using ELISA.
- Clinical data were collected through interviews and chart reviews.
Main Results:
- C. difficile was detected in 14% of children with AGE compared to 28% of HCs (P < .0001).
- This trend was observed in both infants under 1 year and children aged 1-2 years.
- No significant differences were found in PCR cycle threshold values or lactoferrin levels between groups.
Conclusions:
- Healthy children under 2 years old exhibited higher C. difficile detection rates by PCR than children with AGE.
- Real-time PCR alone is not a reliable diagnostic tool for C. difficile disease in children under 2 years old.
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