The changing epidemiology and challenges of paediatric Clostridium difficile infections
School of Medical and Health Sciences
Clostridium difficile (recently also named Clostridioides difficile)1 is an anaerobic spore-forming Gram-positive rod, the leading cause of hospital-acquired diarrhoea in highincome countries and a significant cause of communityacquired diarrhoea2. Since thefirst isolation of C. difficile as a commensal organism in healthy infants in 19353, this ubiquitous pathogen has led a chequered life as a pathogen of children. Despite high rates of C. difficile carriage in infants, they rarely develop clinical symptoms of disease. The reasons for this are not fully understood butmaybe due to a lack of toxin receptors in the gut. Nonetheless, increasing rates of C. difficile infection (CDI) in children have been observed in many parts of the world, especially in children without traditional risk factors, as well as a rising incidence of community-acquired CDI (CA-CDI)4 - this is of concern. This complicated situation is compounded by diagnostic testing issues. Molecular detection methods have been widely implemented in Australia and North America and are more sensitive than toxin enzyme immunoassays (EIAs) or culture5. They are often used routinely in paediatric populations with a high prevalence of C. difficile such as children with malignancies5. Differentiating children who require treatment from those colonised with toxigenic strains remains a challenge for health care providers.