Abstract
BackgroundClostridium difficile infection (CDI) has an increasing pediatric prevalence worldwide. However, molecular characteristics of C. difficile in Chinese children with acute gastroenteritis have not been reported.MethodsA five-year cross-sectional study was conducted in a tertiary children’s hospital in Zhejiang. Consecutive stool specimens from outpatient children with acute gastroenteritis were cultured for C. difficile, and isolates then were analyzed for toxin genes, multi-locus sequence type and antimicrobial resistance. Diarrhea-related viruses were detected, and demographic data were collected.ResultsA total of 115 CDI cases (14.3%), and 69 co-infected cases with both viruses and toxigenic C. difficile, were found in the 804 stool samples. The 186 C. difficile isolates included 6 of toxin A-positive/toxin B-positive/binary toxin-positive (A+B+CDT+), 139 of A+B+CDT−, 3 of A−B+CDT+, 36 of A−B+CDT− and 2 of A−B−CDT−. Sequence types 26 (17.7%), 35 (11.3%), 39 (12.4%), 54 (16.7%), and 152 (11.3%) were major genotypes with significant differences among different antimicrobial resistances (Fisher's exact test, P < 0.001). The A−B+ isolates had significantly higher resistance, compared to erythromycin, rifampin, moxifloxacin, and gatifloxacin, than that of the A+B+ (χ2 = 7.78 to 29.26, P < 0.01). The positive CDI rate in infants (16.2%) was significantly higher than that of children over 1 year old (10.8%) (χ2 = 4.39, P = 0.036).ConclusionsCDI has been revealed as a major cause of acute gastroenteritis in children with various genotypes. The role of toxigenic C. difficile and risk factors of CDI should be emphatically considered in subsequent diarrhea surveillance in children from China.
Highlights
Clostridium difficile infection (CDI) has an increasing pediatric prevalence worldwide
Our study firstly presented the data on community-associated Clostridium difficile infection (CA-CDI) in children with acute gastroenteritis in Zhejiang, China, and provided the pilot evidence to further study clinical significance of routine testing C. difficile in children
115 (14.3%) cases were identified as CA-CDI, 69 (8.6%) cases had coinfections with viruses and 393 (48.9%) cases had neither C. difficile nor virus infections
Summary
Clostridium difficile infection (CDI) has an increasing pediatric prevalence worldwide. The rate of pediatric CDI-related hospitalizations has increased in the past decade in North America and Europe [3,4,5,6]. In the USA, the national rates of CDI-related pediatric hospitalizations have increased from 7.24 to 12.80 per 10,000 hospital admissions, in more than 3700 hospitals, between 1997 and 2006 [3]. One retrospective analysis revealed a 53% increase in the annual incidence density from 2001 to 2006, of 2.6 to 4.0 cases per 1000 admissions involved with 4895 CDI children, from 22 tertiary-care pediatric hospitals [4]. The CDI incidence was 6.6 cases/1000 admissions in a large pediatric hospital in Italy, where most symptomatic children less than 3 years old only had positive C. difficile culture without other gastrointestinal pathogens [5]. The identification of CDI in pediatric population was quite complicated
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