952. Detection of Clostridium difficile by Real-Time Polymerase Chain Reaction in Young Children Does Not Predict Diarrhea
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
  • Pahud - IDSA C diff 10-4-15 FINAL.pdf (874.2 kB)
  • Background: Detection of Clostridium difficile infections (CDI) in young infants with increased frequency of asymptomatic colonization necessitates validation of testing algorithms.  Increased pediatric CDIs have been reported in the setting of hypervirulent NAP 1 strains and migration to PCR-based diagnostic tests. Recent data suggest a high burden of CDI in young children. We compared the frequency of C. difficile detection in young healthy control (HC) children to those with acute gastroenteritis (GE) and evaluated fecal-lactoferrin and organism load as possible markers to differentiate CDI from colonization. 

    Methods: In a multicenter study from January-December 2012, stool was collected from GE patients <2 years old in emergency department or inpatient settings and HC in outpatient clinics. C. difficile and lactoferrin were detected by GeneXpert C diff/ epi PCR (Cepheid Inc. CA) assay and IBD-Scan ELISA (Techlab, VA) respectively. C. difficile load was assessed by PCR cycle threshold (Ct) value for the toxin B gene. Demographic/clinical data were obtained via chart review.  Mann-Whitney U test and Chi-square tests were used for group comparisons.

    Results: Of 524 stools collected, 250 were from GE and 274 HC subjects. HC were younger, more likely female, black and non-Hispanic than GE subjects. Overall, C.difficile was detected in 14.4% (36/250) GE and 28% (76/274) HC stools (p<0.0001); 18% GE vs 32% HC in <1 yr old (p <0.005), and 10% GE vs 21 % HC in 1-2 yr old subjects (p <0.02). Ct values did not differ in GE vs. HC patients. Only 3 NAP1 strains were identified (2 in HC). Recent antibiotic use was reported by 12% (31/250) of GE subjects, of whom 16% (5/31) were C. difficile positive. Lactoferrin levels were higher in GE vs. HC (127 vs 18 ug/ml, p=0.002) and breastfed vs. not breastfed children (363 vs. 26 ug/ml, p<0.0001) but did not differ in C. difficile positive vs. negative (p = 0.79) stools from GE/HC.

    Conclusion: C. difficile detection by real-time PCR alone does not differentiate CDI from colonization in children <2 yrs old, nor do lactoferrin levels or C. difficile load. Most positive PCR tests in children < 2 yrs old represent colonization as HC subjects had higher positivity rates than GE subjects.  Better diagnostic modalities are needed to identify CDI in young children.

    Barbara Pahud, MD MPH1, Christopher Harrison, M.D., FSHEA, FPIDS2, Ferdaus Hassan, PhD3, Natasha Halasa, MD, MPH, FPIDS4, James D. Chappell, MD, PhD5, Janet Englund, MD, FIDSA6, Eileen Klein, MD, MPH7, Peter G Szilagyi, MD, MPH8, Geoffrey Weinberg, MD, FIDSA, FPIDS9, Christopher Polage, MD10, Mary E. Wikswo, MPH11, L. Clifford Mcdonald, MD, FSHEA11, Daniel Payne, PhD, MSPH11 and Rangaraj Selvarangan, PhD3, (1)Infectious Diseases, Children's Mercy Hospital, University of Missouri, Kansas City (UMKC), KC, MO, (2)Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO, (3)Children's Mercy Hospital, Kansas City, MO, (4)School of Medicine, Vanderbilt University, Nashville, TN, (5)Vanderbilt University School of Medicine, Department of Pathology, Nashville, TN, (6)Seattle Children's Hospital, Seattle, WA, (7)Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, (8)Univ. Rochester, Rochester, NY, (9)Pediatrics, Univ. of Rochester Sch. of Med. and Dent., Rochester, NY, (10)Pathology and Infectious Diseases, University of California, Davis Medical Center, Sacramento, CA, (11)Centers for Disease Control and Prevention, Atlanta, GA


    B. Pahud, GSK: Research Contractor , Research support
    ROCHE: Research Contractor , Research support
    CDC: Grant Investigator , Grant recipient
    NIH: Grant Investigator , Research support
    Pfizer: Scientific Advisor , Consulting fee

    C. Harrison, None

    F. Hassan, None

    N. Halasa, Sanofi Pasteur: Grant Investigator , Grant recipient , Research grant and Research support
    Gilead: Grant Investigator , Research support
    Pfizer: Grant Investigator , Grant recipient , Research grant and Research support
    Baxter: Grant Investigator , Grant recipient , Research grant and Research support
    Biocryst: Grant Investigator , Research support

    J. D. Chappell, None

    J. Englund, None

    E. Klein, None

    P. G. Szilagyi, None

    G. Weinberg, None

    C. Polage, Cepheid: Investigator , Research reagents & materials (test kits)
    Alere: Investigator , Speaker honorarium
    Nanosphere: Grant Investigator , Research grant and Salary
    Meridian: Investigator , Research reagents & materials (test kits)
    TechLab: Investigator , Research reagents & materials (test kits)

    M. E. Wikswo, None

    L. C. Mcdonald, None

    D. Payne, None

    R. Selvarangan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.