Program Schedule

Exposure to Gastric Acid-Suppression Therapy is Associated with Healthcare-Associated and Community-Associated C. difficile Infection in Children

Session: Poster Abstract Session: Pediatric Healthcare associated Infection Epidemiology and Prevention
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Acid-suppression therapy, particularly with proton pump inhibitors (PPIs), has been associated with an increased risk of C. difficile infection (CDI) and associated diarrhea in adults.  Limited data exist regarding such an association in children.

Methods: To determine whether gastric acid-suppression therapy is associated with CDI in both inpatient and outpatient pediatric populations, we conducted a retrospective case-control study at a 200-bed academic pediatric hospital and associated outpatient clinics in the time frame 2005-2010.  We defined cases as children 1-18 years of age with a first positive test for C. difficile toxin A/B (Meridian Bioscience) on liquid stool, and matched each case to 2 controls without C. difficile. We conducted chart review to elicit selected comorbidities and exposure to gastric acid-suppression therapy (including H2 blockers and PPIs) and antibiotics in the 3 months preceding the infection or encounter date.  We used bivariate and multivariable logistic regression to evaluate the association between antacid use and CDI, controlling for potential confounders.

Results: We identified 138 children with CDI (61% community-associated, the remainder healthcare-related or indeterminate) and 276 controls.  Use of any acid suppression therapy was more common in cases compared to controls (34% vs.20%, p <0.01).  When adjusted for demographic variables and comorbidities, gastric acid-suppression therapy remained significantly associated with CDI (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.01-3.10). Antibiotic use (aOR, 1.7; 95% CI, 1.1-2.7) and immunosuppressed state (aOR, 2.5; 95% CI, 1.2-5.2) were also associated with CDI in our adjusted model.

Conclusion: Gastric acid-suppression therapy was associated with both healthcare-associated and community-associated CDI in children.  Larger pediatric studies are necessary to determine the role of PPIs specifically in causing CDI in children.

Jennifer Jimenez1, Marci Drees, MD, MS, FACP2, Beth Loveridge-Lenza, M.D.3, Stephen Eppes, M.D.2 and Fernando Delrosario, M.D.4, (1)Jersey Shore University Medical Center, Newark, NJ, (2)Christiana Care Health System, Newark, DE, (3)Jersey Shore University Medical Center, Neptune, NJ, (4)Nemours / Alfred I. duPont Hospital for Children, Wilmington, DE


J. Jimenez, None

M. Drees, None

B. Loveridge-Lenza, None

S. Eppes, None

F. Delrosario, None

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