Clostridium difficile isolation in children hospitalized with diarrhoea

Abstract

Abstract Introduction Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhoea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonisation in this setting. Materials and methods A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhoea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhoea. Risk factors for CDI were identified by multivariate analysis. Results Two hundred and fifty children with acute diarrhoea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n = 31; adenovirus n = 3). The estimated incidence of CDI was 3 cases/1000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhoea, CDI was associated with comorbidity (P Conclusions The isolation of Clostridium difficile is common in hospitalized children with diarrhoea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in paediatrics, especially the percentage of asymptomatic carriers.