title: Clinical Significance of Clostridium difficile in Children Less Than 2 Years Old: A Case-Control Study.
abstract: BACKGROUND
  The significance of Clostridium difficile (CD) in the stools of children 2 years old or younger remains unclear. The aim of this study was to investigate risk factors and clinical evolution of diarrheic children ≤2 years old with or without CD in their stools.
  
  
  METHODS
  From January 1, 2012 to December 31, 2013, all diarrheic stool samples received in our laboratory were screened for CD. We randomly selected diarrheic children ≤2 years old (n = 100) with an isolation of toxigenic CD in the stools and compared them with diarrheic children (n = 100) without isolation of CD.
  
  
  RESULTS
  Cases and controls were appropriately matched for age and sex. We found no significant differences between children with or without CD. Of the CD cases, we compared the patients receiving treatment with metronidazole (19%) versus those that were not prescribed treatment (81%), and found that patients in the first group had used more gastric acid suppressants (P = 0.02), had surgery in the last month (P = 0.03) and also presented with more days with diarrhea (P = 0.03). All the patients, including CD cases, independently of the administration of metronidazole, were cured of the diarrheic episode. Polymerase chain reaction-ribotyping performed in all CD cases showed that the most prevalent ribotype was 014 (25%).
  
  
  CONCLUSIONS
  Our study reinforces the nonsignificance of CD in neonates and infants younger than 2 years old. Informing clinicians of CD isolates in this population promotes the use of antibiotics against CD, without evidence of a different outcome than those not receiving treatment.
authors.affiliation: From the *Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; †Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; ‡Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; and §CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Madrid, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: González-Del Vecchio
authors.forename: Ana
authors.initials: A
authors.lastname: Álvarez-Uria
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marin
authors.forename: Luis
authors.initials: L
authors.lastname: Alcalá
authors.forename: Adoración
authors.initials: A
authors.lastname: Martín
authors.forename: Pedro
authors.initials: P
authors.lastname: Montilla
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D017714:Community-Acquired Infections; D003428:Cross Infection; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors