Clostridium difficile infection in children hospitalized due to diarrhea

Abstract

The frequency of Clostridium difficile infection (CDI)-related hospitalizations is increasing. The aim of this study was to determine the extent of CDI among children hospitalized with diarrhea, risk factors or predictors for severe CDI, the prevalence of NAP1, and to compare the course of CDI depending on bacteria toxicity profile. A retrospective analysis of case records of 64 children (age range 3 months-16 years, median age 2.12 years) with CDI as defined by diarrheal disease and positive polymerase chain reaction (PCR) test (Xpert C. difficile) was conducted. Modified national adult guidelines were used to assess the severity of CDI. CDIs represented 2.7 % of patients with diarrhea (13.5 cases per 1,000 admissions). Thirty-three CDIs (52 %) were community-associated. Antibacterial use preceded CDI in 61 patients (95 %). Seventeen cases (27 %) were binary toxin-positive (CDT+), 13 of which were NAP1 (20.5 %). Over 75 % of CDIs with NAP1 was hospital-acquired, and more often proceeded with generalized infection (p < 0.05). Risk factors for severe CDI (34 %) included NAP1 [odds ratio (OR), 4.85; 95 % confidence interval (Cl), 1.23, 21.86) and co-morbidities (OR, 4.25; 95 % Cl, 1.34, 14.38). Diarrhea ≥10 stools daily was associated with severe CDI (p = 0.01). Recurrence occurred in three patients (4.5 %). There was no mortality. C. difficile is an important factor of antibiotic-associated diarrhea in children. Co-morbidities and NAP1 predispose to severe CDI.

Fig. 1

a The incidence of Clostridium difficile infection (CDI) in children hospitalized due to diarrhea according to age. b CDI-related hospitalizations as a proportion of all pediatric hospitalizations in the age groups

Fig. 2

The etiology of diarrhea among hospitalized children. The numbers and percentages do not sum to the total number of patients with diarrhea or 100 % because some children had multiple etiological factors

Fig. 3

The CDI strains distribution

Fig. 4

Exposure to antibiotics during the 6 weeks preceding CDI. The numbers and percentages do not sum to the total number of patients with diarrhea or 100 % because some children had multiple antibiotics. (AM-CL amoxicillin/clavulanic acid, Amox amoxicillin, Ceph III third-generation cephalosporin, Ceph II second-generation cephalosporin, AMK amikacin, Clarithro clarithromycin, TMP-SMX trimethoprim–sulfamethoxazole, Clinda clindamycin, MER meropenem)