Detection And Clinical Characteristics Of Clostridium Difficile Infection In Children With Acute Diarrhea

Objective Collect stool specimens of children with acute diarrhea hospitalized in Tianjin Children's Hospital from August 2017 to July 2018,Detect the Clostridium difficile toxin(T-cd)gene of them.To understand whether Clostridium difficile infection(CDI)exists in children with acute diarrhea in Tianjin,then areaidentify the pathogenic strains of CD infection,and the positive rate of Clostridium difficile infection in hospitalized children of Tianjin,the results were compared with those of children in other areas.Meanwhile,the clinical data of positive children were analyzed,Screening for infection of Norovirus(NoV)in children,analysis the co-infection with CD,At the same time,the difference of clinical data between CDI children and NoV positive children was compared.To provide evidence for the detection,treatment and prevention of this disease.Methods Collected 1590 stool specimens from children with diarrhoea admitted to Tianjin Children's Hospital from August 2017 to July 2018,extract the DNA of the samples by TIANGEN DNA Extraction Kit.Then detect the Clostridium difficile toxin A/B(Tcd-A/B)gene by polymerase chain reaction(PCR).At the same time,NoV infection was screened by PCR.,Collect the clinical data of positive children,then make statistical analysis.Meanwhile,clinical data of diarrhea children with positive NoV test were collected and compared with those with CD infection.Results Among 1590 stool specimens,79 were positive,with a positive rate of4.97%.Among them,15 were A+B+ patients and 64 were A-B+ patients.No A+Bpatients were detected.410 cases were NoV positive,the positive rate was 25.79%.21 cases were mixed infection,the mixed infection rate was 26.58%(21/79).There was no significant difference in the positive rate of Tcd in sex,age and season,However,the positive rate of NoV was not significantly different in gender and age,but there was significant difference in season,and it was mainly concentrated in winter.Of the positive children,65(82.28%)of patients had a history of antibiotic use within one month before admission.At the same time,38(48.10%)had vomiting.70(88.61%)had a fever,31(39.24%)had anemia,27(34.18%)had an increase of C-reactive protein(CRP),10(12.66%)had a decrease of albumin,29(36.71%)had granulocytosis,3(3.80%)had hypokalemia,7(8.86%)had hyperkalemia,12(15.19%)had creatinine elevation.The positive children were divided into A+B+ group and A-B+ group.There were no significant differences in sex ratio,age,course of disease,frequency of diarrhea,use of antibiotics,proportion of children with fever,proportion of children with anemia,CRP and leukocyte between the two group.58 children with CD infection were compared with 50 children with only NoV positive.There were no significant differences in sex ratio,age,course of disease,frequency of diarrhea,proportion of mucous stool,proportion of blood stool,proportion of vomitingchildren,proportion of fever children,hemoglobin value,erythrocyte,leukocyte,neutrophil,albumin,CRP value and proportion of hypokalemia between the two groups.There were significant differences in the proportion of antibiotics used,dehydration,sepsis,and children with co-infection.Conclusion The study shows that,CD infection exists in hospitalized children with acute diarrhea in this area,mainly A-B+.However,the positive rate was slightly lower than that of children with chronic persistent diarrhea in other areas.Most of the positive children had used antibiotic,at the same time,it can be accompanied by fever,vomiting,anemia,hypoproteinemia,increased CRP,granulocytosis,High potassium,low potassium and increased serum creatinine.The proportion of antibiotics used in CDI group was significantly higher than that in NoV positive group.The complications of CDI group were mainly manifested by infection of various systems.The combined proportion of dehydration,sepsis in NoV positive group was significantly higher than that in CDI group.It is suggested that the influence of antibiotic use history on children with CDI is more significant.But the specific impact needs further study.While the degree of diarrhea caused by NoV was more obvious than that caused by CDI,severe diarrhea can easily cause a series of complications such as dehydration and disturbance of acid-base balance.