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Clostridium difficile in a pediatric outpatient population
Insights
Clostridium difficile (C. difficile) is present in some otherwise healthy children. This study found C. difficile in 7% of outpatient children with diarrhea, suggesting it may be part of normal gut flora.
Area of Science:
- Microbiology
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- Clostridium difficile is a known cause of hospital-acquired diarrhea in children.
- The prevalence of C. difficile in outpatient pediatric populations with diarrhea remains largely unestablished.
- Understanding C. difficile carriage in non-hospitalized children is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To determine the prevalence of Clostridium difficile in outpatient children presenting with diarrhea.
- To compare C. difficile isolation rates between children with diarrhea and age-matched controls without diarrhea.
- To investigate potential risk factors, such as antibiotic exposure, associated with C. difficile isolation in this population.
Main Methods:
- A 1-year prospective study involving 306 outpatient children (2 weeks to 16 years).
- Stool cultures were performed for C. difficile and other bacterial enteric pathogens.
- Patients were categorized into diarrheal and non-diarrheal (control) groups.
Main Results:
- Clostridium difficile was isolated from 7.0% of children with diarrhea and 14.8% of controls.
- Patients positive for C. difficile were significantly younger.
- No significant difference in recent antibiotic exposure was observed between positive and negative cases; C. difficile was rarely found with other pathogens.
Conclusions:
- Clostridium difficile is present in a notable percentage of outpatient children, including those without diarrhea.
- The organism may be a component of normal intestinal flora in children beyond the neonatal period.
- Clinical presentation and antibiotic history did not reliably distinguish C. difficile carriers.
Abstract:
Clostridium difficile has been implicated as one cause of hospital-acquired diarrhea in children, yet the prevalence of this organism in outpatient children with diarrhea has not been established. Over a 1-year period, 306 outpatient children ranging in age from 2 weeks to 16 years were cultured for C. difficile and potential bacterial pathogens. C. difficile was isolated from 7.0% of patients with diarrhea (12 of 171) and 14.8% of controls with nondiarrheal illnesses (20 of 135). The 32 patients yielding C. difficile were significantly younger than the other study patients. C. difficile was isolated in conjunction with another enteric pathogen in only one case. Antibiotic exposure in the month prior to culture was no different between the 32 positive patients and the overall population. Moreover the patients yielding C. difficile were clinically indistinguishable from the other study patients. C. difficile appears to comprise part of the normal bowel flora in some children beyond the neonatal period and despite a negative history of recent antibiotic usage.