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Clinical Significance of Clostridium difficile in Children Less Than 2 Years Old: A Case–Control Study

González-Del Vecchio, Marcela MD; Álvarez-Uria, Ana MD; Marin, Mercedes PharmD, PhD; Alcalá, Luis PharmD; Martín, Adoración PharmD, PhD; Montilla, Pedro MD, PhD; Bouza, Emilio MD, PhD

The Pediatric Infectious Disease Journal: March 2016 - Volume 35 - Issue 3 - p 281–285
doi: 10.1097/INF.0000000000001008
Original Studies

Background: The significance of Clostridium difficile (CD) in the stools of children 2 years old or younger remains unclear. The aim of this study was to investigate risk factors and clinical evolution of diarrheic children ≤2 years old with or without CD in their stools.

Methods: From January 1, 2012 to December 31, 2013, all diarrheic stool samples received in our laboratory were screened for CD. We randomly selected diarrheic children ≤2 years old (n = 100) with an isolation of toxigenic CD in the stools and compared them with diarrheic children (n = 100) without isolation of CD.

Results: Cases and controls were appropriately matched for age and sex. We found no significant differences between children with or without CD. Of the CD cases, we compared the patients receiving treatment with metronidazole (19%) versus those that were not prescribed treatment (81%), and found that patients in the first group had used more gastric acid suppressants (P = 0.02), had surgery in the last month (P = 0.03) and also presented with more days with diarrhea (P = 0.03). All the patients, including CD cases, independently of the administration of metronidazole, were cured of the diarrheic episode. Polymerase chain reaction-ribotyping performed in all CD cases showed that the most prevalent ribotype was 014 (25%).

Conclusions: Our study reinforces the nonsignificance of CD in neonates and infants younger than 2 years old. Informing clinicians of CD isolates in this population promotes the use of antibiotics against CD, without evidence of a different outcome than those not receiving treatment.

Supplemental Digital Content is available in the text.

From the *Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; and §CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Madrid, Spain.

Accepted for publication September 9, 2015.

Funded by Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.

Partial results of this study were presented in the 54th ICAAC 2014, Washington DC, USA.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Marcela González-Del Vecchio, MD, Clinical Microbiology and Infectious Disease, Hospital General Universitario “Gregorio Marañón,”C/ Dr. Esquerdo, 46, 28007 Madrid, Spain. E-mail:

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