BACKGROUND: Pediatric Clostridium difficile infection (CDI)-related hospitalizations are increasing. We sought to describe the epidemiology of pediatric CDI at a quaternary care hospital. METHODS: Nested case-control study within a cohort of children <18 years tested for C. difficile between January and August 2008. The study included patients who were ≥ 1 year with a positive test and diarrhea; those without diarrhea (ie, presumed colonization) were excluded. Two unmatched controls per case were randomly selected from patients ≥ 1 year with a negative test. Potential predictors of CDI included age, gender, comorbidities, prior hospitalization, receipt of C. difficile-active antibiotics in the prior 24 hours, and recent (≤ 4 weeks) exposure to antibiotics or acid-blocking medications. Multivariate logistic regression models were created to identify independent predictors of CDI. RESULTS: Of 1891 tests performed, 263 (14%) were positive in 181 children. Ninety-five patients ≥ 1 year with CDI were compared with 238 controls. In multivariate analyses, predictors of CDI included solid organ transplant (odds ratio [OR], 8.09; 95% confidence interval [CI], 2.10-31.12), lack of prior hospitalization (OR, 8.43; 95% CI, 4.39-16.20), presence of gastrostomy or jejunostomy (G or J) tube (OR, 3.32; 95% CI 1.71-6.42), and receipt of fluoroquinolones (OR, 17.04; 95% CI, 5.86-49.54) or nonquinolone antibiotics (OR, 2.23; 95% CI, 1.18-4.20) in the past 4 weeks. Receipt of C. difficile-active antibiotics within 24 hours before testing was associated with a lower odds of CDI (OR, 0.22; 95% CI, 0.09-0.58). CONCLUSIONS: Recent antibiotic exposure and certain comorbid conditions (solid organ transplant, presence of a gastrostomy or jejunostomy tube) were associated with CDI. Diagnostic testing has less utility in patients being treated with C. difficile-active antibiotics.
BACKGROUND: Pediatric Clostridium difficileinfection (CDI)-related hospitalizations are increasing. We sought to describe the epidemiology of pediatric CDI at a quaternary care hospital. METHODS: Nested case-control study within a cohort of children <18 years tested for C. difficile between January and August 2008. The study included patients who were ≥ 1 year with a positive test and diarrhea; those without diarrhea (ie, presumed colonization) were excluded. Two unmatched controls per case were randomly selected from patients ≥ 1 year with a negative test. Potential predictors of CDI included age, gender, comorbidities, prior hospitalization, receipt of C. difficile-active antibiotics in the prior 24 hours, and recent (≤ 4 weeks) exposure to antibiotics or acid-blocking medications. Multivariate logistic regression models were created to identify independent predictors of CDI. RESULTS: Of 1891 tests performed, 263 (14%) were positive in 181 children. Ninety-five patients ≥ 1 year with CDI were compared with 238 controls. In multivariate analyses, predictors of CDI included solid organ transplant (odds ratio [OR], 8.09; 95% confidence interval [CI], 2.10-31.12), lack of prior hospitalization (OR, 8.43; 95% CI, 4.39-16.20), presence of gastrostomy or jejunostomy (G or J) tube (OR, 3.32; 95% CI 1.71-6.42), and receipt of fluoroquinolones (OR, 17.04; 95% CI, 5.86-49.54) or nonquinolone antibiotics (OR, 2.23; 95% CI, 1.18-4.20) in the past 4 weeks. Receipt of C. difficile-active antibiotics within 24 hours before testing was associated with a lower odds of CDI (OR, 0.22; 95% CI, 0.09-0.58). CONCLUSIONS: Recent antibiotic exposure and certain comorbid conditions (solid organ transplant, presence of a gastrostomy or jejunostomy tube) were associated with CDI. Diagnostic testing has less utility in patients being treated with C. difficile-active antibiotics.
Authors: Jonathan D Crews; Hoonmo L Koo; Zhi-Dong Jiang; Jeffrey R Starke; Herbert L DuPont Journal: Pediatr Infect Dis J Date: 2014-09 Impact factor: 2.129
Authors: Joseph A Spinner; Claire E Bocchini; Ruth A Luna; Santosh Thapa; Miriam A Balderas; Susan W Denfield; William J Dreyer; Dorottya Nagy-Szakal; Faith D Ihekweazu; James Versalovic; Tor Savidge; Richard Kellermayer Journal: Pediatr Transplant Date: 2019-10-16
Authors: Andrej Steyer; Monika Jevšnik; Miroslav Petrovec; Marko Pokorn; Štefan Grosek; Adela Fratnik Steyer; Barbara Šoba; Tina Uršič; Tjaša Cerar Kišek; Marko Kolenc; Marija Trkov; Petra Šparl; Raja Duraisamy; W Ian Lipkin; Sara Terzić; Mojca Kolnik; Tatjana Mrvič; Amit Kapoor; Franc Strle Journal: Pediatr Infect Dis J Date: 2016-09 Impact factor: 2.129
Authors: V Sathyendran; G N McAuliffe; T Swager; J T Freeman; S L Taylor; S A Roberts Journal: Eur J Clin Microbiol Infect Dis Date: 2014-05-09 Impact factor: 3.267