Toxigenic Clostridium difficile colonization in children

Abstract Clostridium difficile is a Gram positive, spore-forming organism that has become a significant cause of nosocomial infection in hospitalized adults. Colonization with this organism results in a wide spectrum of clinical conditions, including an asymptomatic carrier state, mild self-limited diarrhea, pseudomembranous colitis, and fulminant colitis. It’s role in disease in children remains controversial. This is a prospective study in which we evaluated all the patients hospitalized in the infectious diseases ward of Mofid Children’s Hospital, Tehran during 12 months (between September 2006 and September 2007). Stool samples from 250 patients were cultured for C. difficile and specimens analyzed for detection of toxin A and B. Data were analyzed by SPSS software version 11.5. Stool culture was positive for C. difficile in 113 (45.2%) patients, 10 (4%) of these were positive for both toxins A and B by enzyme-linked immunosorbent assay (ELISA). ELISA was negative in all patients with negative culture. None of the variables tested (age and antibiotic exposure) was significantly correlated with colonization. This is the first study about colonization rates of C. difficile in children in Iran. We conclude that although the C. difficile colonization rate in our children is high (45.2%), the rate of toxigenic strains is low (4%). This may explain the low rate of C. difficile associated disease (CACD) in our population.