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Analysis of risk factors for community-acquired Clostridioides difficile diarrhea in children: a case-control study
Yong Zhou1, Liping He1, Cuimei Chen1
1School of Public Health, Xiangnan University, Chenzhou, China.
Insights
Community-acquired Clostridium difficile infection (CA-CDI) in children is rising. Antibiotic use and not being breastfed are key risk factors for pediatric CA-CDI.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Clostridium difficile infection (CDI) studies predominantly focus on adults.
- Pediatric CDI cases, particularly community-acquired CDI (CA-CDI), are increasing.
- This study investigates toxin gene characteristics and risk factors for CA-CDI in children with diarrhea.
Purpose of the Study:
- To identify the prevalence of specific toxin genes in pediatric CA-CDI cases.
- To determine independent risk factors associated with CA-CDI in children presenting with diarrhea.
- To inform prevention strategies for pediatric CDI.
Main Methods:
- A case-control study involving children with diarrhea admitted between June 2021 and June 2022.
- Detection of Clostridioides difficile (CD) toxin genes (tcdA, tcdB, cdtA, cdtB) using fluorescence real-time PCR.
- Multivariate conditional logistic regression analysis to identify risk factors for CA-CDI.
Main Results:
- Out of 193 stool specimens, 16 cases of CD were identified (8.3%).
- The prevalent genotypes were tcdA and tcdB positive (7.25%). Binary toxin genes were not detected.
- Antibiotic use within the past month (OR=5.13) and non-breastfeeding (OR=4.89) were significant risk factors for CA-CDI.
Conclusions:
- Children with a history of antibiotic treatment and those not breastfed are more vulnerable to CDI.
- Prudent use of antibiotics and promoting breastfeeding are crucial for preventing pediatric CA-CDI.
- Understanding these risk factors is vital for clinical practice and public health interventions.
Background:
Most previous studies on Clostridium difficile infection (CDI) mainly focused on adults with underlying diseases or critical illnesses. However, the number of CDI cases in children has also significantly increased, especially the growth of community-acquired CDI, which has attracted attention. This study was conducted to examine the toxin gene characteristics and the risk factors associated with community-acquired CDI (CA-CDI) in children with diarrhea.
Methods:
Children with diarrhea before admission or within 48 hours of hospitalization were included in the study. Stool samples were collected from children with community-acquired diarrhea who were treated at the Children's Hospital of the First People's Hospital of Chenzhou, China from June of 2021 to June of 2022. Fluorescence real-time polymerase chain reaction was utilized to detect Clostridioides difficile (CD) toxins A (tcdA) and B (tcdB) genes as well as binary toxin gene A (cdtA) and B (cdtB) in the specimens cultured for CD. Each child with CA-CDI was matched with four control children of the same sex, age, and place of residence. Necessary clinical data were extracted from the hospital's electronic medical record system. Then, a multivariate conditional logistic regression analysis was applied to identify potential risk factors for CA-CDI.
Results:
Sixteen (8.3%) of the 193 stool specimens who tested positive for CD were selected for the case group, and their matching 64 control patients were in the study cohort. The breakdown of the CD genotypes of the 16 positive cases were follows: 14 (tcdA and tcdB+) (7.25%) and 2 (tcdA+ and tcdB) (1.04%). The cdtA and cdtB binary toxin genes were negative in all. The results of multivariate conditional logistic regression analysis identified antibiotic use within the previous month [odds ratio (OR) =5.13; 95% confidence interval (CI): 1.65-15.91] and non-breastfeeding (OR =4.89; 95% CI: 1.11-21.53) as independent risk factors for CDI in pediatric patients experiencing community-acquired diarrhea.
Conclusions:
Children who had been treated with antibiotics and not breastfed were more susceptible to CDI. Therefore, in order to prevent and to control the spread of CD infection, being prudent to the aforementioned high-risk factors is strongly advocated in clinical practice.
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