Baseline stool toxin concentration is associated with risk of recurrence in children with Clostridioides difficile infection.

BACKGROUND: In adults with Clostridioides difficile infection (CDI), higher stool concentrations of toxins A and B are associated with severe baseline disease, CDI-attributable severe outcomes, and recurrence. We evaluated whether toxin concentration predicts these presentations in children with CDI. METHODS: We conducted a prospective cohort study of inpatients aged 2-17 years with CDI who received treatment. Patients were followed for 40 days after diagnosis for severe outcomes (intensive care unit admission, colectomy, or death, categorized as CDI primarily attributable, CDI contributed, or CDI not contributing) and recurrence. Baseline stool toxin A and B concentrations were measured using ultrasensitive single-molecule array assay, and 12 plasma cytokines were measured when blood was available. RESULTS: We enrolled 187 pediatric patients (median age, 9.6 years). Patients with severe baseline disease by IDSA-SHEA criteria (n = 34) had nonsignificantly higher median stool toxin A+B concentration than those without severe disease (n = 122; 3,217.2 vs 473.3 pg/mL; P = .08). Median toxin A+B concentration was nonsignificantly higher in children with a primarily attributed severe outcome (n = 4) versus no severe outcome (n = 148; 19,472.6 vs 429.1 pg/mL; P = .301). Recurrence occurred in 17 (9.4%) of 180 patients. Baseline toxin A+B concentration was significantly higher in patients with versus without recurrence: 4,398.8 versus 280.8 pg/mL (P = .024). Plasma granulocyte colony-stimulating factor concentration was significantly higher in CDI patients versus non-CDI diarrhea controls: 165.5 versus 28.5 pg/mL (P < .001). CONCLUSIONS: Higher baseline stool toxin concentrations are present in children with CDI recurrence. Toxin quantification should be included in CDI treatment trials to evaluate its use in severity assessment and outcome prediction.

Stool Toxin Concentration Does Not Distinguish Clostridioides difficile Infection from Colonization in Children Less Than 3 Years of Age.

In a prospective cohort study, stools from children <3 years with and without diarrhea who were Clostridioides difficile nucleic acid amplification test-positive underwent ultrasensitive and quantitative toxin measurement. Among 37 cases and 46 controls, toxin concentration distributions overlapped substantially. Toxin concentration alone does not distinguish C. difficile infection from colonization in young children.

Perceived weight status and weight change among a U.S. adult sample.

OBJECTIVE: Examine bidirectional associations between weight perception and weight change over time among adults. METHODS: Data are from adult employees (N = 623) across 12 U.S. public high schools participating in a cluster-randomized multilevel weight gain prevention intervention. Data were collected at baseline, 12 months, and 24 months. Perceived weight status (very/somewhat underweight, just right, somewhat overweight, very overweight) were obtained via self-administered surveys. Weight (kg) was measured by trained staff. Change in weight was calculated as the difference between baseline weight and weight at each follow-up time point. Structural equation models were used to assess bidirectional associations of perceived weight status and change in weight over time. Models were adjusted for study condition, gender, age, race/ethnicity, education level, and previous time point. RESULTS: The sample was 65% female with a mean age of 44.6 (SD = 11.3). Nearly two thirds of the sample consisted of people with overweight (38.8%) or obesity (27.3%). Structural equation models indicated that baseline weight predicted subsequent perceived weight status (ß = 0.26; P < 0.001), whereas baseline perceived weight status did not predict subsequent change in weight, adjusting for previous time point and covariates. CONCLUSIONS: Results do not support bidirectional causality between weight perception and weight change in an adult sample.