ArticleJournal of pediatric gastroenterology and nutrition2021
Two-step Testing for Clostridioides Difficile is Inadequate in Differentiating Infection From Colonization in Children.
Article in Journal of pediatric gastroenterology and nutrition, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 36 citations in OpenAlex.
- PediatricJPGN reports · 2026Article
- Clinical impact of toxin detection in children with PCR-confirmed Clostridioides difficile infection.European journal of pediatrics · 2026Observational
- The Gut Microbiome and Butyrate Differentiate Clostridioides difficile Colonization and Infection in Children.The Journal of infectious diseases · 2026Article
- Prevalence and sequelae of asymptomatic Clostridioides difficile colonization in children with inflammatory bowel disease.Journal of pediatric gastroenterology and nutrition · 2025Article
- Review
- The treatment naïve microbiome of pediatric ulcerative colitis and microbial therapeutics: A humbling challenge.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2025Article
- Analysis of clinical characteristics and risk factors of recurrentFrontiers in pediatrics · 2025Article
- Article
- Article
- Longitudinal Profiling of the Intestinal Microbiome in Children with Cystic Fibrosis Treated with Elexacaftor-Tezacaftor-Ivacaftor.medRxiv : the preprint server for health sciences · 2023Article
- Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease.Current gastroenterology reports · 2023Review
- Article
- Prevalence, Risk Factors, and Sequelae of Asymptomatic Clostridioides difficile Colonization in Children with Cystic Fibrosis.Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society · 2023Article
- Clostridioides difficile Infection in Children: Recent Updates on Epidemiology, Diagnosis, Therapy.Pediatrics · 2023Review
- Clostridioides difficile infection in infants: a case report and literature review.Gut pathogens · 2023Article
- Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019.The Journal of pediatrics · 2023Article
- Hospitalization With Clostridioides difficile in Pediatric Inflammatory Bowel Disease: a Population-Based Study.Journal of pediatric gastroenterology and nutrition · 2022Article
- Efficacy and Outcomes of Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Children with Inflammatory Bowel Disease.Journal of Crohn's & colitis · 2022Article
- Epidemiology, Diagnosis, and Treatment of Clostridioides difficile Infection in Immunocompromised Children.Journal of the Pediatric Infectious Diseases Society · 2021Article
- Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease: A Clinician's Dilemma.Journal of the Pediatric Infectious Diseases Society · 2021Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesRecent Infectious Disease Society of America guidelines recommend multistep testing algorithms to diagnose Clostridioides difficile infection (CDI), including a combination of nucleic acid amplification-based testing (NAAT) and toxin enzyme immunoassay (EIA). The use of these algorithms in children, including the ability to differentiate between C. difficile colonization and CDI, however, has not been evaluated.
methodsWe prospectively enrolled asymptomatic pediatric patients with cancer, cystic fibrosis (CF), or inflammatory bowel disease (IBD) and obtained a stool sample for NAAT testing. If positive by NAAT (colonized), EIA was performed. In addition, children with symptomatic CDI who tested positive by NAAT via the clinical laboratory were enrolled, and EIA was performed on residual stool. A functional cell cytotoxicity neutralization assay (CCNA) was also applied to stool samples from both the colonized and symptomatic cohorts.
resultsOf the 225 asymptomatic children enrolled in the study, 47 (21%) were colonized with C. difficile including 9/59 (15.5%) with cancer, 30/92 (32.6%) with CF, and 8/74 (10.8%) with IBD. An additional 41 children with symptomatic CDI were enrolled. When symptomatic and colonized children were compared, neither EIA positivity (44% vs 26%, P = 0.07) nor CCNA positivity (49% vs 45%, P = 0.70) differed significantly or were able to predict disease severity in the symptomatic cohort.
conclusionsUse of a multistep testing algorithm with NAAT followed by EIA failed to differentiate symptomatic CDI from asymptomatic colonization in our pediatric cohort. As multistep algorithms are moved into clinical care, the pediatric provider will need to be aware of their limitations.
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