Abstract:

Background: Clostridium difficile can be found as commensal in the intestine of humans and animals and might be associated with diarrhea diseases. Limited data exist on the prevalence of C. difficile infections in developing countries.

Main Objective: This study aimed at determining the prevalence, associated factors and outcome of the Clostridium difficile infection among children with diarrhea in Mwanza, Tanzania.

Methods: This was a prospective cross-sectional hospital based study with a follow up component conducted at the Bugando Medical Centre (BMC) and Sekou Toure hospital. All admitted children between 2 months and 12 years of age were enrolled into the study between February 2016 and September 2016. Demographic and clinical data were collected using pre-tested data collection tool. From each participant a stool sample was collected and processed within 2 hours of collection. Culture for the Clostridium difficile was done on the chromogenic agar and C. difficile isolates were tested for the glutamate dehydrogenase (GDH) and C. difficile toxins A and B using rapid commercial tests (QUIK CHEK COMPLETE, Alere TECCHLAB, USA). Toxins production was further confirmed by Multiplex PCR. Data were double entered and verified using Microsoft Excel 2007, cleaned and analyzed using STATA version 13 (college station, Texas).

Results: A total of 440 children were enrolled with media age [IQR] 18[11-48] months. Of these, 301 (68.4%) were from BMC and 139 (31.6%) from Sekou Toure. Approximately 242 (55%) were male. Of 440 children admitted with diarrhea, 22 (5%, 95% CI; 2.9-7.0) were found to have Clostridium difficile infection. Predictors of CDI included positive HIV status (OR = 16, 95% CI; 2.6-52.7, P=0.001), Sibling in the household with similar complains as the patient (OR = 6.3, 95% CI; 1.96-20.1, P=0.002), hospital stay of more than five days (OR = 1.16, 95% CI=1.1-1.3, P=0.002), high median body temperature (OR=2.3 95% CI; 1.4-3.8, P=0.001) high stool leucocytes count (OR=1.04 95% CI; 1.01-1.06, P=<0.001 and liquid stool (OR=40.7, 95% CI; 3.4-494.9, P=0.003). Prior antibiotic use was reported in 21 (95.5%) of the 22 children with C. difficile infections. Children infected with CDI had significantly higher median duration of the diarrhea as compared to those without CDI (6[4.10] days vs. 2[2-4] days P=<0.001).

Conclusion: Toxigenic Clostridium difficile infection was present among under-fives with diarrhea and was independently by predicted by positive HIV infection, sibling with similar complains in the household, hospital stay of more than five days, high body temperature, high leucocytesin stool and liquid stool. In addition, C. difficile infection was found to be associated with prolonged hospitalization. Clinicians should use the predictors mentioned above to suspect children with the increased risk of C. difficile infections especially in children with history of antibiotic use.