Detection of <i>Clostridioides difficile</i> by Real-time PCR in Young Children Does Not Predict Disease
Barbara Pahud, Ferdaus Hassan, Christopher J. Harrison, Natasha Halasa, James D. Chappell, Janet A. Englund, Eileen J. Klein, Peter G. Szilagyi, Geoffrey A. Weinberg, Ashley Sherman, Christopher R. Polage, Mary E. Wikswo, L. Clifford McDonald, Daniel C. Payne, Rangaraj Selvarangan
Abstract
OBJECTIVES: Diagnosing Clostridioides difficile infections in young children with high asymptomatic colonization is challenging. We compared the frequency of C difficile detection by polymerase chain reaction (PCR) in healthy control (HC) children with those with acute gastroenteritis (AGE) and evaluated fecal-lactoferrin and organism load as possible indicators of true C difficile infection disease. METHODS: Stool was collected from children &lt;2 years old with AGE and from HCs. C difficile was detected by real-time PCR, and lactoferrin was measured by enzyme-linked immunosorbent assay. Clinical data were obtained via interviews and chart review. Mann–Whitney U test and χ2 tests were used for group comparisons. RESULTS: Of 524 stools collected from 524 children (250 with AGE, 274 HCs), C difficile was detected less in children with AGE (14%, 36 of 250) than in HCs (28%, 76 of 274) stools (P &lt; .0001). Among infants &lt;1 year old (n = 297), C difficile was detected in 18% of children with AGE versus 32% of HCs (P &lt; .005), and among children 1 to 2 years old (n = 227), C difficile was detected in 10% of children with AGE versus 21% of HCs (P &lt; .02). There was no significant difference in C difficile PCR cycle threshold values between children with AGE and HCs or lactoferrin levels in C difficile PCR-positive versus -negative stools. CONCLUSIONS: HC children &lt;2 years of age had higher rates of C difficile detection by PCR than children with AGE; C difficile detection by real-time PCR alone is not a reliable means to diagnose C difficile disease in children &lt;2 years old.