Abstract
BackgroundIn the pediatric population, severe Clostridioides difficile infection (CDI) sometimes occurs, but most cases are asymptomatic. The asymptomatic carriage rate in pediatric populations is reportedly higher than in the adult population. It is difficult to diagnose CDI, even if C. difficile is detected in children with diarrhea. This study aimed to evaluate the positivity rate of toxigenic C. difficile in the pediatric population with diarrhea.MethodsWe collected and retrospectively analyzed gastrointestinal pathogen multiplex PCR results of 960 patients to estimate the positivity rate of toxigenic C. difficile in pediatric populations aged between 0 and 18 years.ResultsThe overall rate of C. difficile toxin B positivity was 10.1% in the stool samples. The positivity rate peaked in 1-year-old infants (29/153, 19.0%) and continually decreased thereafter. The positivity rate we observed was lower than the rates described in the literature. Remarkably, no C. difficile was detected in neonates. Antibiotic usage was inversely related to the positivity rate, especially in infants < 2 years of age. The odds ratio of antibiotics was 0.44 (95% confidence interval (CI) 0.28–0.68; P < 0.001). The presence of concomitant gastrointestinal pathogens was not associated with toxigenic C. difficile positivity.ConclusionsEven though toxigenic C. difficile infection is neither an important nor a common cause of pediatric diarrhea, children can spread it to adults at risk of developing CDI. The pediatric population can act as hidden reservoirs for pathogenic strains in the community.
Highlights
In the pediatric population, severe Clostridioides difficile infection (CDI) sometimes occurs, but most cases are asymptomatic
This study focuses on multiplex PCR, which is increasingly being applied to detect gastrointestinal pathogens and provides additional information on the C. difficile toxin B gene in pediatric patients
Considering how toxigenic C. difficile is acquired in these age groups, our study suggests that multiple factors beyond antibiotic usage might affect the positivity rate
Summary
Severe Clostridioides difficile infection (CDI) sometimes occurs, but most cases are asymptomatic. This study aimed to evaluate the positivity rate of toxigenic C. difficile in the pediatric population with diarrhea. According to the guidelines for pediatric consideration, because of the high prevalence of asymptomatic carriage of toxigenic C. difficile, testing for CDI should not be routinely performed in children under 12 months of age with diarrhea [1, 8]. If they have rare and severe symptoms of pseudomembranous colitis, toxic megacolon, or clinically significant diarrhea, C. difficile testing should be performed. We estimated the positivity rate of C. difficile tcdB and interpreted the results through electronic medical record review
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