Community-acquired Clostridium difficile infection in Serbian pediatric population

Abstract

Carriage of Clostridium (C.) difficile in the intestinum of children, as well as its role in the disease (diarrhea) onset, is still controversial. The aim of this study is to investigate the community-acquired Clostridium difficile infection (CA-CDI) in Serbian pediatric population and to describe the basic clinical characteristics and risk factors for CA-CDI occurrence in Serbian pediatric population. The data obtained from 63 Serbian pediatric patients with CA-CDI and from control group of 126 children with community-acquired diarrhea, whose stool specimens were negative for C. difficile and toxins A/B, were mutually compared. In the current work, we found that children with CA-CDI display a significantly less severe disease clinical presentation than children with diarrheas of other origin. Lethal outcome was noted in two cases, but in children with severe underlying diseases (Crohn's disease and leukemia). By using the multivariate statistical regression model, the following statistically significant risk factors for community-acquired C. difficile-associated diarrhea development were determined: previous application of laxatives (OR = 0.199, CI 0.55-0.79, p = 0.015), general antibiotic use during the previous 2 months (OR = 0.05, CI 0.02-0.17, p < 0.001), and specifically the use of penicillins (OR = 0.112, CI 0.04-0.31, p < 0.0001) and cephalosporins (OR = 0.16, CI 40.06-0.44, p < 0.0001). Antibiotics from the groups of cephalosporins and penicillins were found to be the most important independent risk factors. Laxative application plays a significant role in the community-acquired Clostridium difficile infections in children, with mechanisms that are not completely understood.

Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes—retrospective study

“…In our study, the risk of recurrent CDI significantly increased for patients with diabetes mellitus or ischemic heart disease and for those with higher BMI or higher glucose level on the day of surgery. Similar to Predrag et al, we also revealed an association of relapses with high CRP during the first episode of CDI (Predrag et al, 2020).…”

Molecular characteristics of Clostridium difficile in children with acute gastroenteritis from Zhejiang

“…Despite a colonization rate of toxigenic or non-toxigenic C. difficile of 30-40% in newborns, 30% in infants between 1 and 6 months of age and a reduction to 14% between 6 and 12 months of age, the incidence of CDI has dramatically increased in pediatric populations [34,35]. Meanwhile, CA-CDI cases have increased in young children [6,36,37], along with a simultaneous global increase in studies on CA-CDI in children, in recent years [38][39][40]. However, studies have been more focused on the colonization of C. difficile in children from China [21,22].…”

Clostridioides difficile ribotype distribution in a large teaching hospital in Serbia

“…The NAP1/BI/027 strain has been detected in almost all European countries, with a different prevalence rate. The reports on C. difficile in Serbia are scarce [3][4][5][6][7][8][9][10][11]. Since 2008, the University Hospital for Infectious and Tropical Diseases of the Clinical Center of Serbia in Belgrade has been the central Serbian institution for the treatment of patients with CDI [3].…”