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Clostridioides (Clostridium) difficile in hospitalised children in Cambodia
Lengsea Eng1, Kefyalew Addis Alene2, Deirdre A Collins3
1School of Population Health, Curtin University, Perth, Western Australia, Australia; Department of Laboratory, Calmette Hospital, Phnom Penh, Cambodia.
Insights
Clostridioides difficile infection (CDI) is prevalent in Cambodian children, with antimicrobial use a key risk factor. Novel and non-toxigenic strains are common, highlighting the need for further molecular epidemiology research in Asia.
Area of Science:
- Infectious Diseases
- Microbiology
- Paediatrics
Background:
- Children are potential disseminators of Clostridioides difficile in healthcare and community settings.
- There is a growing global interest in Clostridioides difficile infection (CDI) among paediatric populations.
- Understanding CDI epidemiology in children is crucial for public health strategies.
Purpose of the Study:
- To determine the prevalence of Clostridioides difficile in hospitalised children in Cambodia.
- To identify risk factors associated with Clostridioides difficile infection in this population.
- To characterise the molecular types of circulating Clostridioides difficile strains.
Main Methods:
- Stool samples were collected from hospitalised children in Phnom Penh, Cambodia (June 2022-March 2023).
- Clostridioides difficile was cultured from samples.
- Toxin gene PCR and PCR ribotyping were employed to analyse isolates.
Main Results:
- Clostridioides difficile was detected in 38.5% of 122 hospitalised children.
- Toxigenic strains were found in 25.5% of positive cases, with RT 012 being predominant.
- Novel strains constituted 70% of isolates; antimicrobial use (OR=5.15) and other medications (OR=13.02) were significant risk factors.
Conclusions:
- A high prevalence of Clostridioides difficile was observed in hospitalised Cambodian children.
- The study identified a significant proportion of non-toxigenic and novel strains.
- Further research, including whole genome sequencing, is recommended for molecular epidemiological studies in Asia.
Background:
Children may play an important role in disseminating Clostridioides (Clostridium) difficile within hospital and community settings. In many parts of the world, there has been a recent increase in interest in C. difficile infection (CDI) in paediatric populations.
Objectives:
This study aimed to investigate the prevalence of, risk factors for, and molecular types of C. difficile in hospitalised children in Cambodia.
Methods:
Stool samples were collected from children at the National Paediatric Hospital in Phnom Penh, Cambodia, between June 2022 and March 2023, for C. difficile culture. Toxin gene PCR and PCR ribotyping were performed on all isolates.
Results:
Of 122 hospitalised children recruited, C. difficile was identified in 47 (38.5 %). Toxigenic strains accounted for 25.5 % (12/47), with ribotype (RT) 012 the most predominant (7/12), followed by RTs 014/020 (3/12) and 017 (1/12). Non-toxigenic strains were dominated by RTs QX011, QX675 and 009/QX107. Novel strains represented 70 % (33/47) of isolates. Significant risk factors included antimicrobial use in the week before detection (OR = 5.15; 95 %CI: 1.125-21.21) and current use of other medications (OR = 13.02, 95 %CI: 1.32-128.67). Diarrhoea and abdominal pain were negatively associated with the presence of C. difficile.
Conclusions:
A high prevalence of C. difficile was found in hospitalised children, with a high proportion of non-toxigenic and novel strains. Larger studies are required with whole genome sequencing necessary for characterising novel strains and advancing molecular epidemiological research in Asia.
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