Prevalence and Outcome of Community-Acquired Clostridium Difficile Infection Among Children Admitted with Diarrhoea at Mulago Hospital

Abstract

Background: Clostridium difficile infection (CDI) is a potentially serious emerging infectious disease. CDI is usually considered to be hospital-acquired, causing diarrhoea in as high as 15% of children in healthcare settings during non-outbreak and 64% during outbreak periods in the US. However, recent studies show that the infection is increasingly being acquired from the community even without prior antibiotic use. Globally, few studies have been done to show the contribution of C. difficile in community-onset diarrhoea, and in sub–Saharan Africa, we have not come across any published data on C. difficile in community-onset childhood diarrhoea. Study objective: This study was to determine the prevalence of CDI and to describe the outcome and factors associated with this infection among children aged 2-36 months with diarrhoea at Mulago National Referral Hospital (MNRH). Methods: This was a descriptive cross-sectional/prospective cohort study among children aged 2-36 months admitted with diarrhoea at MNRH. The stool was examined for clostridium difficile toxin A and B using an enzyme-linked immune fluorescent assay. Findings: Out of the 322 children admitted with diarrhoea during the study period, 168 were enrolled. Of the 168 children, there were 107(63.7%) males. The male-to-female ratio was 1.8:1. Their median age was 9.0 months with an Interquartile range of 7-14. The prevalence of CDI in this study was 4/168(2.4%). Three of the children with CDI were male. All the four children with CDI were below 12 months of age. On admission, the mean frequency of diarrhoea was 8.8 (SD 5.6) in children with CDI compared to 6.4 (SD 3.8) in children without. Children with CDI were hospitalised for a longer duration; 7.5 (SD6.5) vs. 4.5 (SD4.5) days in children without. The known risk factors such as HIV, antibiotic use, malnutrition, and age were not significantly associated with CDI. Conclusion:The prevalence of CDI in children with community-acquired diarrhoea at MNRH is low, so routine testing is not necessary. The outcomes of children with CDI did not differ from those without, and the study lacked statistical power to make recommendations on factors associated with CDI.