Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(2) > 1138541

Korean J Pediatr Gastroenterol Nutr. 2010 Sep;13(2):146-153. Korean.
Published online Sep 30, 2010.
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Epidemiology and Clinical Characteristics of Clostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections
Hye Jung Cho, M.D., Eell Ryoo, M.D., Yong Han Sun, M.D., Kang Ho Cho, M.D., Dong Woo Son, M.D. and Hann Tchah, M.D.
Department of Pediatrics, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea.

Corresponding author (Email: )
Received Jul 29, 2010; Revised Aug 02, 2010; Accepted Aug 27, 2010.



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.


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.


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).


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.

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


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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Table 1
Demographic Characteristics of 61 Patients with Clostridium difficile-associated Disease
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Table 2
Clinical Characteristics of 61 Patients with Clostridium difficile-associated Disease
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Table 3
Comparison of Clinical Characteristics between Community-acquired Clostridium difficile-associated Disease and Hospital-acquired Clostridium difficile-associated Disease
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Table 4
Comparison of Laboratory Findings between Community-acquired Clostridium difficile-associated Disease and Hospital-acquired Clostridium difficile-associated Disease
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