Program Schedule

Use of Concomitant Antibiotics During Treatment for Clostridium difficile Infection (CDI) in Pediatric Inpatients

Session: Poster Abstract Session: Pediatric Healthcare associated Infection Epidemiology and Prevention
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • VS PHIS Poster ID Week 2014 FINAL.pdf (488.8 kB)
  • Background: The incidence of Clostridium difficile among children has increased.  The use of concomitant antibiotics during C. difficile infection (CDI) treatment results in an increased risk of recurrent infection.  Reducing unnecessary exposure, especially among immunocompromised patients at greatest risk of recurrence, is a potential antibiotic stewardship target.  The objective of this study was to characterize concomitant antibiotic use among hospitalized children with CDI

    Methods: This retrospective multi-center cohort included children with CDI admitted between 2008 and 2013 to one of 43 US children’s hospitals contributing data to the Pediatric Health Information System.  Patients were included if they were <18 years old on admission, had an ICD-9 code for CDI, and received either oral or intravenous metronidazole or oral vancomycin.  Concomitant antibiotic use was defined as ≥3 consecutive days during which both CDI treatment and non-CDI antibiotics were given on the same day.  ICD-9 and APR-DRG codes were used to identify immunocompromised patients, defined as those with malignancy, solid organ transplant, or bone marrow transplant.  Descriptive statistics were used to summarize concomitant antibiotic use and patient characteristics

    Results: During the study period, 16,777 patients met the definition of CDI, for an observed rate of 5.29 per 1,000 discharges.  After removing antibiotics commonly used for prophylaxis, the prevalence of concomitant antibiotic use was 46%.  The median duration of concomitant use was 7 days (IQR: 4, 11).  The most frequent concomitant agents used were intravenous vancomycin (20%), cefepime (12%), and carbapenems (12%).  Approximately 31% of CDI patients were immunocompromised.  Among these, 64% of patients with malignancy and 79% with transplant received concomitant antibiotics, respectively

    Conclusion: Hospitalized children are commonly prescribed concomitant antibiotics during CDI treatment.  Concomitant antibiotic exposure is frequent for immunocompromised patients, populations at high risk for recurrence.  Antimicrobial stewardship programs should consider interventions to identify potentially modifiable or unnecessary concomitant therapy, especially for immunocompromised patients

    Vanessa Stevens, PhD1, Cary Thurm, PhD2, Matthew Kronman, MD3, Jeffrey S. Gerber, MD, PhD4, Samir Shah, MD, MSCE5, Jason Newland, MD6, Joshua Courter, PharmD7, Sarah Parker, MD8, Thomas Brogan, MD3 and Adam L. Hersh, MD, PhD9, (1)University of Utah College of Pharmacy, Salt Lake City, UT, (2)Children's Hospital Association, Overland Park, KS, KS, (3)Seattle Children's, Seattle, WA, (4)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, (6)Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, (7)Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (8)Infectious Disease, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (9)University of Utah School of Medicine, Salt Lake City, UT


    V. Stevens, None

    C. Thurm, None

    M. Kronman, None

    J. S. Gerber, None

    S. Shah, None

    J. Newland, Pfizer: Grant Investigator, Grant recipient

    J. Courter, None

    S. Parker, None

    T. Brogan, None

    A. L. Hersh, None

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