Clostridioides (Clostridium) difficile in hospitalised children in Cambodia

Background: Children may play an important role in disseminating Clostridioides (Clostridium) difficile within hospital and community settings. In many parts of the world, there has been a recent increase in interest in C. difficile infection (CDI) in paediatric populations. Objectives: This study aimed to investigate the prevalence of, risk factors for, and molecular types of C. difficile in hospitalised children in Cambodia. Methods: Stool samples were collected from children at the National Paediatric Hospital in Phnom Penh, Cambodia, between June 2022 and March 2023, for C. difficile culture. Toxin gene PCR and PCR ribotyping were performed on all isolates. Results: Of 122 hospitalised children recruited, C. difficile was identified in 47 (38.5 %). Toxigenic strains accounted for 25.5 % (12/47), with ribotype (RT) 012 the most predominant (7/12), followed by RTs 014/020 (3/12) and 017 (1/12). Non-toxigenic strains were dominated by RTs QX011, QX675 and 009/QX107. Novel strains represented 70 % (33/47) of isolates. Significant risk factors included antimicrobial use in the week before detection (OR = 5.15; 95 %CI: 1.125–21.21) and current use of other medications (OR = 13.02, 95 %CI: 1.32–128.67). Diarrhoea and abdominal pain were negatively associated with the presence of C. difficile. Conclusions: A high prevalence of C. difficile was found in hospitalised children, with a high proportion of non-toxigenic and novel strains. Larger studies are required with whole genome sequencing necessary for characterising novel strains and advancing molecular epidemiological research in Asia.