Risk Factors for Community-Associated Clostridium difficile Infection in Children
Methods: Children with CA-CDI evaluated at Texas Children’s Hospital from January 1, 2012 through June 30, 2013 were identified. Two control subjects, frequency matched by age group, were randomly selected among children with community-associated diarrhea (symptom onset > 12 weeks after last hospitalization) who tested negative for C. difficile. Data on demographics, medication use, and outpatient healthcare encounters were collected from medical records. Multivariate logistic regression was performed to identify predictors of pediatric CA-CDI.
Results: A total of 69 CA-CDI pediatric cases were identified and compared with 138 control subjects. The majority (62.3%) of CA-CDI cases had an underlying chronic medical condition. CA-CDI cases had exposures to antibiotics (40.6%), gastric acid suppressants (21.7%), and outpatient healthcare settings (66.7%) within 30 days of illness. However, exposure to an antibiotic, gastric acid suppressant, or outpatient healthcare setting was not identified within 30 and 90 days of illness in 23.2% and 15.9% of CA-CDI cases, respectively. On univariate analysis, CA-CDI cases were more likely to have a gastrointestinal feeding device (20.3% vs. 8.0%; P=0.01) than control subjects. Additionally, exposure to cephalosporins (13.0% vs. 4.4%; P=0.02), clindamycin (5.8% vs. 0.7%; P=0.04), and outpatient healthcare settings (66.7% vs. 48.6%; P=0.01) within 30 days of illness were more common in CA-CDI cases than control subjects. On multivariate analysis, CA-CDI was associated with cephalosporin use within 30 days (OR 3.32; 95% CI 1.10-10.01) and the presence of a gastrointestinal feeding device (OR 2.59; 95% CI 1.07-6.30).
Conclusion: A substantial proportion of children with CA-CDI did not have a “traditional” risk factor for CDI. Antibiotics are an important risk factor for CA-CDI in children with risk varying by antibiotic class. Outpatient healthcare settings may be a source of C. difficile acquisition among children in community settings.
K. Waller, None
M. Swartz, None
H. Dupont, None
J. Starke, None
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