Abstract
Clostridioides difficile infections (CDI) are traditionally attributed to adults, but children can also be affected. In children, when indicated, laboratory diagnosis of CDI should be combined with testing for the presence of other gastrointestinal pathogens that are a common cause of diarrhoea, particularly in younger children.
This was also confirmed in a cohort of 652 children with diarrhoea admitted to the Motol University Hospital, where 71 PCR-positive tests for toxigenic C. difficile revealed another infectious cause in 33.8% (n = 24) by multiplex PCR. The detection of toxigenic C. difficile by PCR does not distinguish between colonisation and active infection, so the stool sample with a positive PCR test should be tested also for the presence of toxins A/B.
Of the above 71 PCR-positive stools, 65 were further tested with the immunoenzymatic assay, and simultaneous positivity of C. difficile GDH and A/B toxins was detected only in 44.6% of stools (n = 24), but in almost half of these samples (n = 10), another infectious cause of diarrhoea was detected. In recurrent CDI, as in the first episode, emphasis should be placed on combined laboratory diagnostics to exclude co-infection with another intestinal pathogen or colonization with C. difficile.
Compared with adult inpatients, available clinical data in children are limited and further prospective studies are needed to determine the prevalence of CDI and the efficacy of treatment regimens.