Korean J Pediatr Gastroenterol Nutr.  2010 Sep;13(2):146-153. 10.5223/kjpgn.2010.13.2.146.

Epidemiology and Clinical Characteristics of Clostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections

• Cho HJ
• Ryoo E
• Sun YH
• Cho KH
• Son DW
• Tchah H

• KMID: 1459430
• DOI: http://doi.org/10.5223/kjpgn.2010.13.2.146

Abstract

PURPOSE
Recent studies have reported an increase in the incidence of community-acquired Clostridium difficile-associated disease (CA-CDAD) among children. There is an overall lack of information on CA-CDAD in the pediatric population. The aim of our study was to compare the epidemiologic and clinical features between CA-CDAD and hospital-acquired C. difficile-associated disease (HA-CDAD) in children.
METHODS
We retrospectively reviewed the medical records of all patients who were diagnosed with C. difficile-associated disease (CDAD) at Gil Hospital between April 2008 and March 2009. The diagnosis of CDAD was made when patients with gastrointestinal symptoms had positive results for C. difficile toxins A and B assay or stool culture.
RESULTS
Sixty-one (male, 32 and female, 29) patients were included. The mean age was 3.79+/-4.54 years. Of the 61 patients, 22 (36.1%) were <1 year of age. Twenty-three patients (37.7%) had a history of antibiotic exposure in the previous 3 months. Forty-one patients (67.2%) were diagnosed with CA-CDAD. There were no significant differences in age, gender, symptoms, laboratory findings, recovery period, complications, and recurrence between the CA-CDAD and HA-CDAD groups. On the other hand, exposure to antibiotics was significantly more frequent among patients in the HA-CDAD group (p=0.005).
CONCLUSION
This study suggests that the occurrence of CA-CDAD is increasing in the pediatric population, especially in younger children with no history of exposure to antibiotics and in outpatients. Awareness of the increasing incidence of CA-CDAD and prompt investigation of C. difficile in susceptible patients is needed to avoid misdiagnosis and for appropriate therapy.

Keyword

Clostridium difficile; Children; Diarrhea; Community-acquired infections; Nosocomial infections

MeSH Terms

Anti-Bacterial Agents
Child
Clostridium
Clostridium difficile
Community-Acquired Infections
Cross Infection
Diagnostic Errors
Diarrhea
Female
Hand
Humans
Incidence
Medical Records
Outpatients
Recurrence
Retrospective Studies
Anti-Bacterial Agents

Figure

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  Fig. 1 (A) Sixty-one patients with Clostridium difficile-associated disease (CDAD) are arranged according to age (year). The gray and black columns represent cases of community-acquired CDAD and hospital-acquired CDAD, respectively. (B) Age-specific distribution of 61 patients with CDAD shows progressive decrease in the number of patients after 1~4 years of life.

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