Epidemiology and Clinical Characteristics of<i>Clostridium difficile</i>-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections

Cho, Hye‐Kyung; Ryoo, Eell; Sun, Yong Han; Cho, Kang Ho; Son, Dong Woo; Tchah, Hann

doi:10.5223/kjpgn.2010.13.2.146

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…Antibiotic exposure was more common in the C. difficile -negative group ( P =0.004) ( Table 1 ). These findings may be explained by the results of previous studies showing that the incidence of community-acquired CDCI in infants without antibiotic exposure reached 78% unlike in adults 16) . Moreover, the results suggest that the environmental sources like food, water, and animals, as well as host factors, may play an important role in community-acquired CDCI, and different strain types and genetic diversity of C. difficile can be affect the diverse sources of CDCI 18) .…”

Section: Discussionmentioning

confidence: 79%

“…Although the importance of gut bacteria in allergic diseases is undeniable, how individual bacteria species affect allergic disease development is not yet well known. The increasing incidence of atopy might be due to the increasing incidence of community-acquired C. difficile infection in younger children 16) . The influence of C. difficile colonization and/or infection (CDCI) during infancy after the settlement of normal flora in the gastrointestinal tract on allergic diseases during late childhood remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Clostridium difficile colonization and/or infection during infancy and the risk of childhood allergic diseases

2017

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PurposeThe gut microbiota can influence several diseases through immune modulation; however, the exact role of microbes such as Clostridium difficileand the relationship between microbiota colonization and allergic diseases are not well known. This study aimed to determine the relationship between C. difficilecolonization and/or infection (CDCI) during infancy and allergic diseases during early childhood.MethodsInfants 1–12 months of age presenting changes in bowel habits for more than 2 weeks were enrolled in this study. After dividing them into 2 groups according to the presence and absence of C. difficile, the risk of allergic disease development during childhood was identified and compared.ResultsSixty-five patients were included in this study; 22 (33.8%) were diagnosed with CDCI. No significant differences were observed in baseline characteristics between the C. difficile-positive and -negative groups except for antibiotic exposure (22.7% vs. 60.5%, P=0.004). Compared to the C. difficile-negative group, the risk of developing at least one allergic disease was higher in the C. difficile-positive group after adjusting other variables (adjusted odds ratios, 5.61; 95% confidence interval, 1.52–20.74; P=0.007). Furthermore, food allergies were more prevalent in the C. difficile-positive group (P=0.03).ConclusionCDCI during infancy were associated with a higher risk of developing allergic diseases during early childhood. These results suggest that CDCI during infancy might reflect the reduced diversity of the intestinal microbiota, which is associated with an increased risk of allergic sensitization. To identify the underlying mechanism, further investigation and a larger cohort study will be needed.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Clostridium difficile colonization and/or infection during infancy and the risk of childhood allergic diseases

2017

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“…CDE incidence has been reported to increase with age and the increasing use of antibiotics [ 3 6 ]. However, regardless of the use of antibiotics, incidence of community-acquired C. difficile enteritis (CA-CDE) is steadily increasing in the pediatric population [ 6 7 8 ]. Although not yet proven, CA-CDE appears to be acquired through food, such as meat, seafood and raw products.…”

Section: Introductionmentioning

confidence: 99%

Difference in Vitamin D Levels Between Children with Clostridioides difficile Enteritis and Those with Other Acute Infectious Enteritis

Park

Lee

Ryoo

2021

Pediatr Gastroenterol Hepatol Nutr

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Purpose: A steady increase in Clostridioides difficile enteritis (CDE) has been reported recently. CDE is associated with intestinal dysbiosis, and vitamin D receptors are known to play an important role in this microbial imbalance as immunological regulators. We investigated the difference in vitamin D levels between children with CDE and those with other acute infectious enteritis. Methods: This retrospective study was conducted on children below 18 years of age who visited the Gil hospital, underwent investigation to assess vitamin D levels, and had confirmed gastrointestinal infection between January 2015 and December 2018. Patients were divided into two groups: the "CDE group" (n=18) and the "other infectious enteritis group" (n=88); their clinical characteristics, other laboratory results, and vitamin D levels were analyzed. Results: There was no difference in gender, age, and seasonal distributions between the CDE and other infectious enteritis groups. Other laboratory results were not significantly different between two groups, excluding serum albumin level (4.52±0.45 g/dL vs. 4.31±0.28 g/dL, p=0.011). The mean 25-hydroxy vitamin D level in the CDE group was higher than that in the control group (18.75±8.11 ng/mL vs. 14.50±6.79 ng/mL, p=0.021). Conclusion: Vitamin D levels in the CDE group were lower than normal but higher than the other infectious enteritis group. These results suggested that CDE has a different mechanism or susceptibility associated with vitamin D in children, and even marginal changes in vitamin D levels can act as a risk factor for infection.

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“…Although the intake of excessive antibiotics is the main cause of infectious diarrhea, including CDI, CDI was also reported in low-risk groups of patients not using antibiotics. C. difficile -associated disease (CDAD) causes watery or mucous-containing stools accompanied with abdominal pain and fever [ 4 ]. The frequency of CDAD increases in low-risk groups and is related to functions associated with proton-pump inhibitors (PPIs) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Characterization of Clostridium difficile Strains Isolated from Patients with C. difficile-associated Disease in Korea

Cho

Chon

Seo

et al. 2017

Osong Public Health Res Perspect

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ObjectivesStudies on Clostridium difficile are rare in Korea. We investigated the epidemiological characteristics of C. difficile isolates from patients with C. difficile-associated disease (CDAD) in Korea.MethodsMultiplex polymerase chain reaction was performed to detect the presence of tcdA and tcdB toxin genes. Antimicrobial susceptibility test was carried out by the disk-dilution method. C. difficile strains were subtyped by automated repetitive-element palindromic PCR (rep-PCR).ResultsAmong patients with CDAD, 73 (25.8%), 32 (11.3%), 32 (11.3%), and 26 (9.2%) suffered from pneumonia, cancer or neoplasm, diabetes, and colitis, respectively. Of all stool samples, 43 samples (15.2%) were positive for C. difficile strains. We observed two expression patterns of toxin genes: tcdA+/tcdB+ (86% isolates) and tcdA−/tcdB+ (14% isolates), with all isolates expressing tcdB. Furthermore, some isolates were resistant to clindamycin (65%), ampicillin (56%), and cefazolin (40%), but all were susceptible to vancomycin and metronidazole. The tested samples were classified into diverse clusters using automated rep-PCR.ConclusionOur findings revealed the characteristics and antibiotic resistance of C. difficile isolates from patients in Korea. The epidemiological data may provide valuable insight into development of treatment strategies for C. difficile infections in Korea.

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Epidemiology and Clinical Characteristics ofClostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections

Cited by 7 publications

References 27 publications

Clostridium difficile colonization and/or infection during infancy and the risk of childhood allergic diseases

Clostridium difficile colonization and/or infection during infancy and the risk of childhood allergic diseases

Difference in Vitamin D Levels Between Children with Clostridioides difficile Enteritis and Those with Other Acute Infectious Enteritis

Characterization of Clostridium difficile Strains Isolated from Patients with C. difficile-associated Disease in Korea

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