Clinical Characteristics of Pediatric Clostridioides difficile Infection at a Children's Hospital

The epidemiology and clinical characteristics of pediatric Clostridioides difficile infection (CDI) in Japan have not been well characterized. Unlike in adults, C. difficile colonization is common in children, particularly in those younger than 2 years. This study aimed to characterize pediatric CDI in Japan.

This single-center retrospective observational study included patients at Tokyo Metropolitan Children's Medical Center between April 2010 and May 2024 in whom toxigenic C. difficile was identified by direct stool toxin immunochromatography, toxin testing of isolates recovered by stool culture, or multiplex PCR detection of toxin A/B gene targets. CDI was defined as laboratory evidence of toxigenic C. difficile with compatible gastrointestinal symptoms. Clinical data, including demographic characteristics, underlying conditions, antimicrobial exposure, treatment, severity, outcomes, and recurrence, were extracted from electronic medical records.

Among 262 patients tested, 24 were diagnosed with CDI. Fifteen (62.5%) had negative direct stool toxin tests but toxin-positive isolates obtained from a stool culture. The median age was 5.5 years (interquartile range: 4-10 years); 58% of the patients were male, 75% had received antimicrobial therapy before CDI onset, and 71% had a history of hospitalization. Twelve patients (50%) received CDI-directed antimicrobial therapy, and 12 patients (50%) improved without specific treatment. Fifteen patients (63%) met the study criteria for severe CDI, but only one was admitted to the pediatric intensive care unit. No recurrences were observed, and the 30-day mortality rate was 0%.

Pediatric CDI had favorable outcomes, with no deaths or recurrences occurring in the present study.