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Background In the pediatric population, severe  Clostridioides difficile  infection (CDI) sometimes occurs, but most cases are asymptomatic. The asymptomatic carriage rate in pediatric populations is reportedly higher than in the adult population. It is difficult to diagnose CDI, even if  C. difficile  is detected in children with diarrhea. This study aimed to evaluate the positivity rate of toxigenic  C. difficile  in the pediatric population with diarrhea. Methods We collected and retrospectively analyzed gastrointestinal pathogen multiplex PCR results of 960 patients to estimate the positivity rate of toxigenic  C. difficile  in pediatric populations aged between 0 and 18 years. Results The overall rate of  C. difficile  toxin B positivity was 10.1% in the stool samples. The positivity rate peaked in 1-year-old infants (29/153, 19.0%) and continually decreased thereafter. The positivity rate we observed was lower than the rates described in the literature. Remarkably, no  C. difficile  was detected in neonates. Antibiotic usage was inversely related to the positivity rate, especially in infants &lt; 2 years of age. The odds ratio of antibiotics was 0.44 (95% confidence interval (CI) 0.28–0.68;  P  &lt; 0.001). The presence of concomitant gastrointestinal pathogens was not associated with toxigenic  C. difficile  positivity. Conclusions Even though toxigenic  C. difficile  infection is neither an important nor a common cause of pediatric diarrhea, children can spread it to adults at risk of developing CDI. The pediatric population can act as hidden reservoirs for pathogenic strains in the community.

bmc infectious diseases

Detection of Clostridioides difficile toxin B gene: benefits of identifying gastrointestinal pathogens by mPCR assay in the diagnosis of diarrhea in pediatric patients