Recurrent community-acquired Clostridium(Clostridioides)difficile infection in Serbianchildren

  • Stojanovic PredragEmail author
  • Ed J. Kuijper
  • Stojanović Nikola
  • Karuna E. W. Vendrik
  • Radulović Niko
Original Article


Information on recurrent Clostridium difficile infections (rCDI) in children is rare and limited, especially community acquired (CA-CDI).This study was designed to identify risk factors for rCA-CDI in Serbian pediatric population. The study group included 71 children (aged from 1 to 14 years) with a first episode of CDI. Data were collected from 56 (78.87%) children with only one episode of CA-CDI and from 15 (21.13%) children with rCA-CDI were mutually compared. The following parameters were found to be statistically significantly more frequent in the children with rCA-CDI group (p < 0.05); leukemia as underlying disease, treatment with immunosuppressive and-or cytostatic drugs, and treatment with antibiotics. Similarly, previously visits to outpatient facilities, daycare hospitals and hospitals were also associated with rCDI. Analysis of clinical symptoms and laboratory parameters, revealed a statistically significant association of the severity of the first episode of CDI (determined by an increase in body temperature, higher maximum WBC and higher CRP) with development of a rCDI. Ribotype (RT) 027 was more common in children with rCA-CDI (66.7%, p = 0.006). During the seven-year research period, we found a rate of rCA-CDI rate in children of 21.13%. Our study identified several parameters statistically significantly more frequently in children with rCA-CDI. The obtained results will serve as a basis for future larger studies, but new prospective, studies are necessary to build a prediction model of rCDI in children that can be used to guide the treatment to prevent rCDI.


Clostridium difficile Recurrent CDI Community acquired diarrhea Children Diarrhea 



We thank mrs. Celine Harmanus, technician of the National Reference Laboratory Clostridium difficile Leiden University, The Netherlands, for assistance in designing of ribotyping Clostridium difficile isolates.

Funding Information

This study was funded by the Ministry of Education, Science and Technological Development of Serbia [Projects No. 172061].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Was obtained from parents of all participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of NišNišSerbia
  2. 2.National Reference Laboratory for Anaerobic Infections - Clostridium difficile, Center of MicrobiologyInstitute for Public Health NisNišSerbia
  3. 3.Department of Medical Microbiology, Center for Infectious Diseases, National Reference Laboratory Clostridium difficile, National Institute of Public Health and the EnvironmentLeiden University Medical CenterLeidenThe Netherlands
  4. 4.Department of Chemistry, Faculty of Science and MathematicsUniversity of NišNišSerbia

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