The Clinical and Molecular Epidemiology of Pediatric Clostridium difficile Infection: Predominance of Restriction Endonuclease Analysis (REA) Group DH
Background: The clinical epidemiology of pediatric Clostridium difficile infection (CDI) has been frequently described, but the molecular epidemiology of pediatric CDI is understudied.
Methods: A retrospective cohort study was performed using all laboratory-identified cases of CDI in patients > 1 year old at an academic children's hospital over a 1-year period (12/2012-12/2013). Saved C. difficile toxin B gene PCR-positive stool specimens underwent culture and REA typing.
Results: 189 CDI episodes among 143 patients were included. Of these, 156 (83%) stool specimens were saved by the laboratory, and 132 (85%) were culture positive. The Table and Figure 1 describe the clinical characteristics and disease classification of cases, respectively. Severe CDI and recurrent CDI within 8 weeks occurred in 27 (14%) and 32 (17%) cases, respectively. Recurrent CDI was associated with malignancy (risk ratio [RR] 2.6, 95% confidence interval [CI] 1.4-4.8) and was less likely to occur in patients with community-onset (CO) CDI (RR 0.47, 95% CI 0.24-0.89). Strain BI was identified in 3 CDI cases from the same patient. Strain DH, the predominant strain identified (Figure 2), was not associated with severity or recurrence, but was associated with malignancy (RR 2.2, 95% CI 1.1-4.4), healthcare facility-associated (HCFA) CDI (RR 3.2, 95% CI 1.5-7), and cephalosporin use (RR 4.2, 95% CI 2.1-8.4).
Conclusion: Molecular epidemiologic assessment of pediatric CDI revealed a paucity of BI/NAP1/027 and predominance of DH/NAP11/106, a common epidemic strain in the UK but infrequent in the US. Although DH was not associated with severe or recurrent CDI, DH was associated with cephalosporin use, HCFA-CDI, and malignancy, the latter of which was associated with recurrent CDI.
Table: Clinical Characteristics of Pediatric CDI (n=189)
Merck: Grant Investigator, Grant recipient
Actellion: Board Member, Consulting fee
Merck: Board Member, Consulting fee
Rebiotix: Board Member, Consulting fee
Viropharma: Consultant, Consulting fee
Summit: Consultant, Consulting fee
Viropharma: patent holder, patent
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