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.

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The aim of the study was to analyze the characteristics {sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and credibility} of tests for microbiological diagnosis of infections caused by Clostridium (C. difficile). The research was done at the Public Health InstituteNiš, the Center for Microbiology during the period 2016-2019. The study included 25 patients with Clostridium difficile infection (CDI) (25 fecal samples) and 50 patients with diarrhea who were not diagnosed with CDI (50 faecal samples). The samples were examined by various tests for the detection of toxin in the stool and with two tests to prove the produced glutamate dehydrogenase enzyme -GDH. RIDA GENE Clostridium difficile test (Real Time Multiplex PCR, R-Biofarm, Damstadt, Germany) was used as a reference test.Among the examined tests, the highest sensitivity in toxin detection was the ELISA-ridascreen C. difficile Toxin A / B (R -Biopharm AG, Darmstadt, Germany) (88%, PPV = 85.71%, NPV = 97.87%) and the lowest C. difficile TOXIN A& B -CHEK-1 (VEDALAB, ALENCON CEDEX, France) (68%, PPV = 85%, NPV = 85.45%). All toxin detection tests had a high specificity that was not less than 92%. In detecting the GDH antigen, the Rida ® QUICK C. difficile GDH test (R -Biopharm AG, Darmstadt, Germany) showed better performance (sensitivity 100%, specificity 92%, PPV = 89.28%, NPV = 100% and authenticity 94.66% ).The results of the research conducted in Niš showed high values of the characteristics for certain toxindetecting tests in feces (sensitivity up to 88%, specificity to 98%, etc.). Research results in other studieshave shown that the values of the parameters that determine the characteristics of the tests are lower by 10% -20%, although there is a study whose results are consistent with ours. The reasons for relatively high values should be sought in strict selection criteria for samples that are close to criteria present in factory conditions when designing such tests.O r i g i n a l a r t i c l e 344 Acta facultatis medicae Naissensis 2019; 36(4):343-355 Although the results of this study confirm that there is no ideal diagnostic test in the microbiological diagnosis of CDI, the high sensitivity, specificity, PPV and NPV values make GDH tests suitable for the first screening of sample stools in everyday work.