title: The role of Clostridium difficile and viruses as causes of nosocomial diarrhea in children.
abstract: OBJECTIVE
  We report surveillance of nosocomial diarrhea in children at our institution during the past decade and note different epidemiology of diarrhea due to viruses and Clostridium difficile.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  A university-affiliated pediatric hospital with 180 beds serving an urban area and providing referral care for the Maritime Provinces of Canada.
  
  
  METHODS
  Children younger than 18 years.
  
  
  METHODS
  Surveillance was conducted from 1991 to 1999 using personal contact with personnel and review of microbiology and medical records. Nosocomial diarrhea was defined as loose stools occurring more than 48 hours after admission, with at least two loose stools in 12 hours and no likely non-infectious cause.
  
  
  RESULTS
  Nosocomial diarrhea was the third most common nosocomial infection (217 of 1,466; 15%), after bloodstream and respiratory infections, with from 0.5 to 1 episode per 1,000 patient-days. Of 217 nosocomial diarrhea episodes, 122 (56%) had identified pathogens: C. difficile (39 of 122; 32%), rotavirus (38 of 122; 31%), adenovirus (36 of 122; 30%), and other viral (9 of 122; 7%). The median age was 1.3 years (range, 11 days to 17.9 years), 0.80 year for children with viral diarrhea, 3.9 years for children with C. difficile, and 1.5 years for children with diarrhea without a causative organism identified (P< .0001). Most children with nosocomial diarrhea were incontinent (diapered) at the time of their first episode (138 of 185; 75%), but preexisting incontinence was more common in those with viral diarrhea (93%) compared with those with no organism identified (71%) or those with C. difficile-associated diarrhea (CDAD) (49%) (P <.0001).
  
  
  CONCLUSIONS
  C. difficile is the single most common cause of nosocomial diarrhea in our tertiary-care center, although all viral pathogens account for 69% of cases. Diapered status appears to be a risk factor for CDAD in children, and CDAD occurs more often in older children than viral nosocomial diarrhea. Further characterization of risk factors for, and morbidity associated with, nosocomial CDAD in children is warranted.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Langley
authors.forename: John C
authors.initials: JC
authors.lastname: LeBlanc
authors.forename: Martha
authors.initials: M
authors.lastname: Hanakowski
authors.forename: Olga
authors.initials: O
authors.lastname: Goloubeva
mesh_terms: D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000821:virology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000821:virology; D041381:Diapers, Infant / Q000382:microbiology / Q000821:virology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology; D004196:Disease Outbreaks; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D009674:Nova Scotia / Q000453:epidemiology; D011159:Population Surveillance; D018571:Sentinel Surveillance