Nosocomial Clostridium difficile-associated diarrhoea in Assiut University Children’s Hospital, Egypt

Abstract

Background: There are no large epidemiological studies of Clostridium difficile-associated disease (CDAD) in hospitalised children.

Aim: To describe the frequency, demography, clinical features and outcome of nosocomial CDAD in children admitted to Assiut University Children’s Hospital, Egypt.

Patients and Methods: In this descriptive cross-sectional study, 72 children developed nosocomial diarrhoea between April 2010 and March 2011. A medical history, clinical assessment and culture for Clostridium difficile and direct toxin detection from stool samples by enzyme immuno-assay were undertaken in all patients.

Results: CDAD was diagnosed in 17 (23·6%) patients. Those aged ≤12 months were the most commonly affected (eight, 47%). The main cause of admission was respiratory disorders (eight, 47% of cases), followed by surgical problems (three, 17·7%). Ten patients (58·8%) had severe symptoms. There were no statistically significant differences between any of the demographic or laboratory data for children with CDAD and children with other causes of nosocomial diarrhoea. None of the patients developed complications. Seven children with CDAD (41·2%) had recurrence.

Conclusion: CDAD is an important cause of nosocomial diarrhoea in children in Assiut University Children’s Hospital. Established guidelines should be followed in all hospitals to minimise exposure to the pathogen. Physicians can do much to reduce the risk of a severe outcome in children by early identification and rapid management. Further research should be undertaken to identify the risk factors for recurrence.

Keywords:

• Clostridium difficile
• Nosocomial diarrhoea
• Children

Acknowledgements

The authors are grateful to the infection control unit, nurses and health-care workers in Assiut University Children’s Hospital for their assistance with the study.