title: Clinical and Microbiological Characteristics of Clostridium difficile Infection Among Hospitalized Children in the Netherlands.
abstract: BACKGROUND
  Little is known about pediatric Clostridium difficile infection (CDI) epidemiology. We describe the clinical and microbiological characteristics of CDI among hospitalized children in the Netherlands.
  
  
  METHODS
  Between May 2009 and May 2015, 26 hospitals registered characteristics of pediatric (aged 2-18 years) and adult (aged 18 years) CDI in a national sentinel surveillance study. Routine polymerase chain reaction (PCR) ribotyping and multiple-locus variable-number tandem-repeat analysis (MLVA) of selected strains was performed. Pediatric and adult results were compared using proportion and 95% confidence interval (CI). Time trend of pediatric CDI was evaluated using a mixed-effect Poisson model.
  
  
  RESULTS
  Pediatric CDIs were reported in 17 of the 26 participating hospitals (n = 135; 3% of all CDIs); the monthly number was constant over time. The median age of pediatric cases was 10 years (interquartile range, 4.7-14.5 years). Fifty-five percent of the children had community onset and 31% had severe CDI. Compared with adults (n = 4,556), complication and mortality rates were lower. Clostridium difficile PCR ribotype 265 (toxin A negative, B positive) was most prevalent in children (15%; 95% CI, 8.8%-24.0%) but rarely found in adults (1%; 95% CI, 0.9%-1.6%). This strain was rarely found in other countries, except for Belgium. MLVA showed genetic relatedness between three-fourths of pediatric and adult ribotype 265 strains, without a clear epidemiological link.
  
  
  CONCLUSIONS
  Pediatric CDI in hospitals has remained stable over the last 6 years and resulted in fewer complications than for adult CDI. Further studies are needed to elucidate the source and epidemiology of PCR ribotype 265, primarily found in children.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, The Netherlands; and.
authors.forename: Sofie M
authors.initials: SM
authors.lastname: van Dorp
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, The Netherlands; and.
authors.forename: Edela
authors.initials: E
authors.lastname: Smajlović
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, The Netherlands; and.
authors.forename: Cornelis W
authors.initials: CW
authors.lastname: Knetsch
authors.affiliation: Centre for Infectious Disease Control, the National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Daan W
authors.initials: DW
authors.lastname: Notermans
authors.affiliation: Centre for Infectious Disease Control, the National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Sabine C
authors.initials: SC
authors.lastname: de Greeff
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, The Netherlands; and.
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D021521:Ribotyping; D063189:Symptom Assessment
keywords: 
  Clostridium difficile
  ; CDI; pediatric; ribotyping.; surveillance