Scott Anjewierden1, Zheyi Han1, Charles B Foster2, Chaitanya Pant3, Abhishek Deshpande4. 1. Cleveland Clinic Lerner College of Medicine,Case Western Reserve University,Cleveland, Ohio,USA. 2. Center for Pediatric Infectious Diseases,Cleveland Clinic Children's,Cleveland, Ohio,USA. 3. Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine,University of Kansas Medical Center,Kansas City, Kansas,USA. 4. Medicine Institute Center for Value Based Care Research,Cleveland Clinic,Cleveland, Ohio,USA.
Abstract
OBJECTIVE: To summarize risk factors for Clostridioides (formerly Clostridium) difficile infection (CDI) in hospitalized pediatric patients as determined by previous observational studies. DESIGN: Meta-analysis and systematic review. PATIENTS: Studies evaluating risk factors for CDI in pediatric inpatients were eligible for inclusion. METHOD: We systematically searched MEDLINE, Web of Science, Scopus, and EMBASE for subject headings and text words related to CDI and pediatrics from 1975 to 2017. Two of the investigators independently screened studies, extracted and compiled data, assessed study quality, and performed the meta-analysis. RESULTS: Of the 2,033 articles screened, 14 studies reporting 10,531,669 children met the inclusion criteria. Prior antibiotic exposure (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31-3.52) and proton pump inhibitor (PPI) use (OR, 1.33; 95% CI, 1.07-1.64) were associated with an increased risk of CDI in children. Subgroup analyses using studies reporting only adjusted results suggested that prior antibiotic exposure is not a significant risk factor for CDI. H2 receptor antagonist (H2RA) use (OR, 1.36; 95% CI, 0.31-5.98) and that female gender (OR, 0.87; 95% CI, 0.74-1.03) did not play a significant role as a risk factor for developing CDI. CONCLUSION: Prior antibiotic exposure appears to be an important risk factor for CDI based on the combined analysis but not significant using adjusted studies. PPI use was associated with an increased risk of CDI. Judicious and appropriate use of antibiotics and PPIs may help reduce the risk of CDI in this vulnerable population.
OBJECTIVE: To summarize risk factors for Clostridioides (formerly Clostridium) difficileinfection (CDI) in hospitalized pediatric patients as determined by previous observational studies. DESIGN: Meta-analysis and systematic review. PATIENTS: Studies evaluating risk factors for CDI in pediatric inpatients were eligible for inclusion. METHOD: We systematically searched MEDLINE, Web of Science, Scopus, and EMBASE for subject headings and text words related to CDI and pediatrics from 1975 to 2017. Two of the investigators independently screened studies, extracted and compiled data, assessed study quality, and performed the meta-analysis. RESULTS: Of the 2,033 articles screened, 14 studies reporting 10,531,669 children met the inclusion criteria. Prior antibiotic exposure (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31-3.52) and proton pump inhibitor (PPI) use (OR, 1.33; 95% CI, 1.07-1.64) were associated with an increased risk of CDI in children. Subgroup analyses using studies reporting only adjusted results suggested that prior antibiotic exposure is not a significant risk factor for CDI. H2 receptor antagonist (H2RA) use (OR, 1.36; 95% CI, 0.31-5.98) and that female gender (OR, 0.87; 95% CI, 0.74-1.03) did not play a significant role as a risk factor for developing CDI. CONCLUSION: Prior antibiotic exposure appears to be an important risk factor for CDI based on the combined analysis but not significant using adjusted studies. PPI use was associated with an increased risk of CDI. Judicious and appropriate use of antibiotics and PPIs may help reduce the risk of CDI in this vulnerable population.