Incidence and importance of Clostridium difficile in paediatric diarrhoea in Brazil.
Clostridium difficile strains were detected in 14 of 210 (6.7 %) faecal samples from children in Rio de Janeiro, Brazil, by cultivating faeces on cycloserine/cefoxitin/fructose agar after alcohol-shock. Two main groups of children were studied: inpatients (n = 96) and outpatients (n = 114). The inpatient group consisted of children on antibiotics or immunosuppressors who presented with diarrhoea and other children who did not present with diarrhoea and were not under an antibiotic or chemotherapeutic regimen. Among the outpatients, two groups were examined: namely, a group that comprised children who presented with diarrhoea and were occasionally under an antibiotic regimen and another group that comprised patients who were not taking antibiotics. After cytotoxic assay, toxigenic C. difficile (Cd tox+) strains were detected in 4.2 % of inpatients and 3.5 % of outpatients. Exclusion of other infectious causes of diarrhoea indicated a typical case of C. difficile-associated paediatric diarrhoea in the community. Among Cd tox+ isolates, no variations were detected by PCR for toxin A that employed primers NK9 and NKVO11. No resistance was found to metronidazole or vancomycin among strains that were isolated from children who presented with diarrhoea, but the MIC(50) and MIC(90) values for clindamycin were 6-8 and 16 microg ml(-1), respectively. Resistance to clindamycin seems to be more disseminated in strains from outpatients than in those from inpatients (P < 0.05). In conclusion, these data suggest that investigation for C. difficile infection should be taken into account in paediatric diarrhoea in both inpatients and outpatients in developing countries.
Pinto
Leandro J F
LJF
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
Alcides
Ana P P
APP
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
Ferreira
Eliane O
EO
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
Avelar
Kátia E S
KES
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
Sabrá
Aderbal
A
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
Domingues
Regina M C P
RMCP
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
Ferreira
M Candida S
MCS
Universidade Federal de Juiz de Fora, MG, Brazil 2Instituto de Microbiologia Professor Paulo de Góes, UFRJ, RJ, Brazil 3Instituto Oswaldo Cruz, Fiocruz, RJ, Brazil 4Universidade do Grande Rio, RJ, Brazil.
D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000494:pharmacology; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008826:Microbial Sensitivity Tests
D002981:Clindamycin