title: Community-acquired Clostridium difficile infection in children: A retrospective study.
abstract: BACKGROUND
  Community acquired-Clostridium difficile infection (CDI) has increased also in children in the last years.
  
  
  OBJECTIVE
  To determine the incidence of community-acquired CDI and to understand whether Clostridium difficile could be considered a symptom-triggering pathogen in infants.
  
  
  METHODS
  A five-year retrospective analysis (January 2007-December 2011) of faecal specimens from 124 children hospitalized in the Niguarda Ca' Granda Hospital for prolonged or muco-haemorrhagic diarrhoea was carried out. Stool samples were evaluated for common infective causes of diarrhoea and for Clostridium difficile toxins. Patients with and without CDI were compared for clinical characteristics and known risk factors for infection.
  
  
  RESULTS
  Twenty-two children with CDI were identified in 5 years. An increased incidence of community-acquired CDI was observed, ranging from 0.75 per 1000 hospitalizations in 2007 to 9.8 per 1000 hospitalizations in 2011. Antimicrobial treatment was successful in all 19 children in whom it was administered; 8/22 CDI-positive children were younger than 2 years. No statistically significant differences in clinical presentation were observed between patients with and without CDI, nor in patients with and without risk factors for CDI.
  
  
  CONCLUSIONS
  Our study shows that Clostridium difficile infection is increasing and suggests a possible pathogenic role in the first 2 years of life.
authors.affiliation: Pediatrics Division Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Borali
authors.affiliation: Microbiology Service, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ortisi
authors.affiliation: Pediatrics Division Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Pediatrics Division Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Elisabetta Francesca
authors.initials: EF
authors.lastname: Stacul
authors.affiliation: Pediatrics Division Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Lipreri
authors.affiliation: Microbiology Service, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Giovanni Pietro
authors.initials: GP
authors.lastname: Gesu
authors.affiliation: Pediatrics Division Niguarda Ca' Granda Hospital, Milan, Italy. Electronic address: costantino.degiacomo@ospedaleniguarda.it.
authors.forename: Costantino
authors.initials: C
authors.lastname: De Giacomo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents
keywords: Clostridium difficile; Diarrhoea; Infectious disease