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Clostridium difficile infection in children: Microbiology, pathogenesis, and epidemiology

Jonathan Crews, MD, MS
Section Editor
Sheldon L Kaplan, MD
Deputy Editor
Mary M Torchia, MD


Clostridium difficile is an important cause of antibiotic-associated diarrhea and one of the most common health care-associated infections [1]. It causes a wide-spectrum of illnesses from asymptomatic colonization or mild diarrhea to fulminant disease characterized by toxic megacolon, sepsis, and death. C. difficile infection is less common in children than adults, but the incidence of C. difficile infection in children is increasing [2-5].

The microbiology, pathogenesis, and epidemiology of C. difficile infection in children will be discussed below. The clinical features, diagnosis, treatment, and prevention of C. difficile infection in children are discussed separately. (See "Clostridium difficile infection in children: Clinical features and diagnosis" and "Clostridium difficile infection in children: Treatment and outcome" and "Clostridium difficile infection: Prevention and control".)

C. difficile infection in adults also is discussed separately. (See "Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology" and "Clostridium difficile infection in adults: Clinical manifestations and diagnosis" and "Clostridium difficile in adults: Treatment".)


Organism — C. difficile is an anaerobic, Gram-positive, spore-forming, toxin-producing bacillus. It exists in spore form in the environment. The spores are metabolically dormant and resistant to heat, acid, antibiotics, and most disinfectants. Once C. difficile spores reach the intestine, they germinate into the vegetative form, which is capable of producing toxins and is susceptible to killing by antimicrobial agents.

C. difficile is widely distributed in nature. It has been found in water, soil, food products (vegetables and retail meat), farm animals, and households [6-10]. Within health care facilities, C. difficile has been cultured from the hands of patients and health care personnel, hospital surfaces, medical equipment, and hospital pet therapy dogs [11,12]. C. difficile can persist on hospital surfaces for months [11].

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Literature review current through: Nov 2017. | This topic last updated: Oct 19, 2017.
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