Korean J Pediatr Gastroenterol Nutr KJPGN Korean Journal of Pediatric Gastroenterology and Nutrition 1229-0114 2093-5633 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition 10.5223/kjpgn.2010.13.2.146 Original Article Gastrointestinal Tract Epidemiology and Clinical Characteristics of Clostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections Cho Hye Jung M.D. Ryoo Eell M.D. Sun Yong Han M.D. Cho Kang Ho M.D. Son Dong Woo M.D. Tchah Hann M.D. Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea. Corresponding author (irida@medimail.co.kr) 09 2010 30 09 2010 13 2 146 153 29 07 2010 02 08 2010 27 08 2010 Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition 2010 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.

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(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.

Demographic Characteristics of 61 Patients with Clostridium difficile-associated Disease

Clinical Characteristics of 61 Patients with Clostridium difficile-associated Disease

Comparison of Clinical Characteristics between Community-acquired Clostridium difficile-associated Disease and Hospital-acquired Clostridium difficile-associated Disease

Comparison of Laboratory Findings between Community-acquired Clostridium difficile-associated Disease and Hospital-acquired Clostridium difficile-associated Disease