Objective To analyze the risk factors for Clostridioides difficile colonization and clinical characteristics of C. difficile-associated diarrhea in children and provide reference for the improvement of medical staff understands of C. difficile-associated diarrhea, the stratified management of hospitalized children and evaluation of C. difficile infection risk in children.

Methods Between September 2022 and August 2023, children who were positive for C. difficile in Affiliated Dazu's Hospital of Chongqing Medical University, People's Hospital of Dazu were included in the study. Additionally, Healthy children undergoing simultaneous physical examinations were included as control. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for C. difficile colonization in children. The laboratory detection results and clinical manifestation of two groups of infected children were compared.

Results A total of 120 children who were positive for C. difficile were included in the study, in whom 60 had C. difficile colonization and 60 had C. difficile-associated diarrhea, and they were classified as C. difficile positive group. 60 healthy children were included. The univariate and multivariate logistic regression analyses identified several independent risk factors for C. difficile colonization in children, including hospitalization in the past 3 months (OR=2.13, P=0.02), antibiotic use in the past 30 days (OR=1.87, P=0.02), and proton pump inhibitor use (OR=2.42, P=0.01). In the children with C. difficile-associated, the predominant strain was tcdA⁺tcdB⁺ (85.00%, 51/60). The clinical manifestations mainly included: acute diarrhea (68.33%, 41/60), watery stool (41.67%, 25/60), and fever (20.00%, 12/60). In comparison with the C. difficile colonization group, the C. difficile-associated diarrhea group exhibited significantly higher levels of C-reactive protein and white blood cell, as well as significantly lower levels of albumin and hemoglobin ( P<0.05).

Conclusion Pediatric C. difficile colonization is associated with several risk factors, including hospitalization within the three months prior to admission, antibiotic use in the past 30 days, and proton pump inhibitor use. The majority of C. difficile isolates from children infected with C. difficile exhibited the tcdA⁺ and tcdB⁺ genotype, consistent with virulent strain profiles. Clinical manifestations mainly included watery stool and fever. Laboratory tests can indicate elevated levels of C-reactive protein and white blood cells, alongside decreased levels of albumin and hemoglobin.