Detection of Clostridioides Difficile Toxin B Gene: Benefits of Identifying Gastrointestinal Pathogens by mPCR Assay in the Diagnosis of Diarrhea in Pediatric Patients

Abstract In the pediatric population, severe Clostridioides difficile infection sometimes occurs, but most cases are asymptomatic. Since the asymptomatic carriage rate is reportedly high in pediatric populations, diagnosis of CDI is difficult. Here, we analyzed 960 results of gastrointestinal pathogen multiplex PCR to estimate the positive rate of toxigenic C. difficile in pediatric populations aged between 0 and 18 years. The overall rate of C. difficile toxin B positivity was 10.1% in the stool samples. The positive rate peaked in 1-year-old infants (29/153, 19.0%), and decreased continually thereafter. The positive 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 positive rate, especially in infants < 2 years of age. The odds ratio of antibiotics was 0.44 (95% confidence interval (CI) 0.28–0.68; P < 0.001). The presence of concomitant gastrointestinal pathogens was not associated with toxigenic C. difficile positivity. Even though toxigenic C. difficile infection is neither an important nor a common cause of pediatric diarrhea, children can spread it to adults who are at risk of developing CDI. Pediatric population can act as hidden reservoirs for pathogenic strains in the community.