Clostridioides (Clostridium) difficile in children and adolescents in the community in Cambodia

Clostridioides (Clostridium) difficile transmission between community and healthcare settings has been increasingly reported. We aimed to identify the prevalence and molecular epidemiology of C. difficile colonising adolescents and non-hospitalised children in Cambodia.

Stool samples were collected from 266 students at the University of Health Sciences (UHS) in Phnom Penh, between July and August 2022, and 246 children ≥1 year old visiting the outpatient department (OPD) at Angkor Hospital for Children in Siem Reap, between January and August 2022. C. difficile culture, toxin gene detection and PCR ribotyping were performed.

Overall, C. difficile was recovered from 07/266 specimens (2.6 %) from UHS students and 59/246 specimens (23.9 %) from OPD children. The overall prevalence of C. difficile in children peaked in April, and of toxigenic strains peaked in August. Children with loose stools were less likely to be colonised by C. difficile (COR = 0.05, 95 %CI: 0.008-0.32) than children with normal stools. UHS students were colonised only by toxigenic C. difficile. Of the 66 isolates, 36 % (24/66) were toxigenic: C. difficile ribotype (RT) 017 was the most predominant, followed by RTs 012, 046, 056, QX709, 001, 014/020 and QX710. Non-toxigenic strains accounted for 35 RTs including 32 novel RTs that had not been isolated previously.

The findings of only toxigenic strains in adolescents and the high prevalence of C. difficile in OPD children suggest exposure to C. difficile within the community; thus, appropriate interventions may be needed. Genotypic identification of diverse C. difficile is important for molecular epidemiological purposes.