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Clostridium difficile in young children. Association with antibiotic usage
Insights
Clostridium difficile is common in young children, particularly those receiving antibiotics. Most carriage states are asymptomatic in children under two years old.
Area of Science:
- Microbiology
- Pediatrics
- Infectious Diseases
Background:
- Clostridium difficile is an opportunistic pathogen.
- Antibiotic use is a known risk factor for C. difficile infection.
- The prevalence and clinical significance in young children are not fully understood.
Purpose of the Study:
- To investigate the prevalence of Clostridium difficile in hospitalized children aged 0-2 years.
- To compare C. difficile carriage in children with and without diarrhea.
- To identify risk factors and clinical outcomes associated with C. difficile in this age group.
Main Methods:
- Stool samples were collected from 52 children with diarrhea and 52 controls.
- C. difficile was isolated by stool culture.
- Toxin detection was performed.
- Antibiotic history and follow-up data were collected.
Main Results:
- C. difficile was isolated from 21% of children with diarrhea and 33% of controls (no significant difference).
- Children with C. difficile had significantly higher prior antibiotic use (p < 0.001).
- Toxin was detected in 1 diarrhea case and 5 controls. C. difficile cleared in most children within 4-6 months, with persistence linked to further antibiotic exposure.
Conclusions:
- Clostridium difficile is frequently present in the stools of young children.
- Prior antimicrobial therapy is associated with increased C. difficile carriage.
- Most C. difficile carriage states are asymptomatic in children under two years old.
Abstract:
Clostridium difficile was isolated from the stools of 11/52 (21%) of children aged 0 to 2 years hospitalized with diarrhoea, and from 17/52 (33%) of a control group of hospitalized children with no diarrhoea; this difference was not significant. Direct demonstration of C. difficile toxin from the stools was positive in 1 case with diarrhoea and in 5 control cases. The children with positive stool culture for C. difficile had had significantly more treatments with antibiotics or chemotherapeutics than those with negative C. difficile culture (3.3 +/- 2.7 vs. 1.6 +/- 1.8, p less than 0.001), but there was no significant difference in the incidence of diarrhoea in the past. During a 4-6-month follow-up, C. difficile disappeared from the stools of 24 out of 28 initially culture-positive children; 3 of the 4 children with persistent C. difficile had received antibiotics during the follow-up period. We conclude that the presence of C. difficile is common in the stools of young children up to the age of 2 years, and that C. difficile is more frequently found in children who have received antimicrobial therapy. Most cases of C. difficile carriage state are symptomless at this age.