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


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.

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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.


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

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Correspondence to Stojanovic Predrag.

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Predrag, S., Kuijper, E.J., Nikola, S. et al. Recurrent community-acquired Clostridium(Clostridioides)difficile infection in Serbianchildren. Eur J Clin Microbiol Infect Dis 39, 509–516 (2020).

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  • Clostridium difficile
  • Recurrent CDI
  • Community acquired diarrhea
  • Children
  • Diarrhea