Background An increase in paediatric Clostridium difficile (CD) infection incidence has been reported. Yet, its epidemiology and treatment schedules are not certain. We aim to describe the CD incidence, clinical presentation, treatment and outcomes in a children tertiary hospital.

Methods Data from Clostridium difficile identified cases by enzyme immunoassay (EIA), during 2010 and 2013, in Hospital Dona Estefânia (Portugal).

Results Eleven cases were identified, 73% during 2013. Three children less than 12 months old were excluded (probable colonisation). A median age of 8,7 years was observed, with a highest incidence between children older than 10 years. Six of the cases were not hospitalised. In 62%, the only symptom was diarrhoea. Among the eight cases, five (62%) received multiple antibiotics before the CD detection, three (37%) had a gastrointestinal disease and three (37%) had recently undergone surgery. Six children (75%) received treatment with metronidazol and no complications or deaths were reported. Recurrence was observed in two cases, with one child having three subsequent CD infection episodes.

Conclusions In our study, the majority of children was not hospitalised, which is in agreement with the recent epidemiologic trends in Clostridium difficile infection. Antibiotic exposure remains the most common and modifiable risk factor, emphasising the importance of searching CD in this group of children.