Faculty of Medicine, University of Niš, Zorana Đinđića 81, Niš, 18000, Serbia.
National Reference Laboratory for Anaerobic Infections-Clostridium difficile, Center of Microbiology, Institute for Public Health Nis, Niš, 18000, Serbia.
Eur J Clin Microbiol Infect Dis. 2018 Jun;37(6):1061-1069. doi: 10.1007/s10096-018-3218-6. Epub 2018 Mar 1.
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.
艰难梭菌（C. difficile）在儿童肠道中的携带情况及其在疾病（腹泻）发病中的作用仍存在争议。本研究旨在调查塞尔维亚儿科人群中的社区获得性艰难梭菌感染（CA-CDI），并描述塞尔维亚儿科人群中 CA-CDI 发生的基本临床特征和危险因素。将 63 例 CA-CDI 塞尔维亚儿科患者和 126 例社区获得性腹泻的儿童（粪便标本为艰难梭菌和毒素 A/B 均为阴性）的对照组的资料进行相互比较。在本研究中，我们发现 CA-CDI 患儿的疾病临床表现明显较轻。两名患儿死亡，但均患有严重的基础疾病（克罗恩病和白血病）。通过使用多变量统计回归模型，确定了与社区获得性艰难梭菌相关腹泻发展相关的以下具有统计学意义的危险因素：既往使用泻药（OR=0.199，95%CI 0.55-0.79，p=0.015），在过去 2 个月中常规使用抗生素（OR=0.05，95%CI 0.02-0.17，p<0.001），特别是使用青霉素（OR=0.112，95%CI 0.04-0.31，p<0.0001）和头孢菌素（OR=0.16，95%CI 40.06-0.44，p<0.0001）。头孢菌素和青霉素类抗生素被认为是最重要的独立危险因素。泻药的应用在儿童社区获得性艰难梭菌感染中起重要作用，但机制尚不完全清楚。
