Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature

H. de Graaf, S. Pai, D. A. Burns, J. A. Karas, David Enoch*, S. N. Faust

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

20 Citations (Scopus)


Although Clostridium difficile is a major cause of antibiotic-associated diarrhoea in adults, the incidence and severity of C. difficile infection (CDI) in children is unclear. One complicating factor in assessing the role of CDI in children is the possibility of co-infection with other gastrointestinal pathogens. In this review, we summarise the literature concerning C. difficile co-infections in young children, in an attempt to discuss the rate of co-infections and their potential role in the severity of CDI clinical presentation. We identified 31 studies where co-infections were analysed, comprising 1,718 patients with positive C. difficile tests. The pooled percentage of reported co-infections was 20.7 % (range 0–100 %). Viral co-infections were most commonly reported (46 %), with bacteria and parasites accounting for 14.9 % and 0.01 % of cases, respectively. However, the panel of co-infections tested for varied considerably among studies and 38 % of stated co-infections did not have a pathogen reported. Substantial variation in how and when tests for gastrointestinal co-infections are carried out, small sample sizes and a lack of clear CDI case definitions preclude meaningful conclusions on the true rate of co-infections in this patient population. This review suggests that co-infections may be common in children with diarrhoea who tested positive for C. difficile. Given a lack of CDI case definitions, especially in young children under the age of 5 years, a broad panel of pathogens should be tested for to exclude other microbiological causes. However, the summarised poor quality of the available literature on this subject highlights a need for further studies.

Original languageEnglish
Pages (from-to)1281-1287
Number of pages7
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Issue number7
Publication statusPublished - 23 Jul 2015

Bibliographical note

Funding Information:
DAB and JAK are employees of Astellas Pharma EMEA. DAE has received funding from Astellas Pharma EMEA for attendance at a scientific congress. SNF received funding from Astellas, Cubist and Actelion to attend an international meeting of experts in 2013 to discuss generic issues related to conducting trials of C. difficile in infants and has attended advisory boards for vaccine and antimicrobial manufacturers. All honoraria are paid to the university or hospital, with no personal payment of any kind.

Publisher Copyright:
© 2015, Springer-Verlag Berlin Heidelberg.


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