1466. Clinical and Microbiologic Assessment of Cases of Pediatric Community-Associated C. difficile Infection Reveals Opportunities for Improved Testing Decisions
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Kociolek IDWeek 2015 Poster FINAL.pdf (2.4 MB)
  • Background: Although most pediatric C. difficile infections (CDIs) are community-associated (CA), many children with CA-CDI lack classic risk factors. Use of highly sensitive PCR testing in low risk children may lead to CDI misdiagnosis by identifying C. difficile carriers with an alternate diarrheal etiology.

    Methods: To assess likelihood of CDI misdiagnosis in low-risk children, we retrospectively compared hospital-onset healthcare facility-associated (HO-HCFA) CDIs and CA-CDIs (i.e., children who have not been hospitalized in the previous 12 weeks) diagnosed by tcdB (i.e., toxin B gene) PCR at an academic children’s hospital over a 1-year period. We additionally compared CA-CDIs with and without outpatient exposures in the previous 12 weeks. Saved tcdB-positive stools also underwent anaerobic stool culture and multiplex gastrointestinal (GI) pathogen PCR testing.

    Results: 74 children with CA-CDI were compared to 25 children with HO-HCFA CDI. Children thought to have CA-CDI were more frequently < 2 years old (18% vs. 0%, p=0.034) and less likely to have antibiotic exposure in the past 30 days (26% vs. 88%, p<0.0001), proton pump inhibitor (PPI; 16% vs. 36%, p=0.036) exposure, or a gastrostomy tube (11% vs. 32%, p=0.013). Of the 74 CA-CDIs, 30 (41%) had no outpatient exposures in the previous 12 weeks. CA-CDI cases lacking recent outpatient exposures were more likely to be < 2 years old (30% vs. 9%, p=0.029) and less likely to have inflammatory bowel disease (17% vs. 48%, p<0.01), PPI exposure (0% vs. 27%, p<0.01), and C. difficile isolated by culture (71% vs. 95%, p<0.01). Only 3 children in the cohort were tested by their healthcare provider for a viral GI pathogen other than rotavirus. Among children with CA-CDI, additional multiplex PCR testing of tcdB-positive stools identified a viral GI pathogen in 26% of stools and failed to identify C. difficile among 23% of stools. Compared to stools testing positive for C. difficile using the multiplex PCR panel, stools testing negative were more likely to also test negative for C. difficile by culture (40% vs. 9%, p=0.008).

    Conclusion: Many children diagnosed with CA-CDI by tcdB PCR lack classic risk factors and have discordant results when additional CDI testing methods are performed. More selective CDI testing in low-risk pediatric populations is needed to more accurately diagnose CDI and limit unnecessary CDI antibiotic treatment in children.

    Larry Kociolek, MD1,2, Sameer Patel, MD, MPH1,2, Stanford Shulman, MD, FIDSA, FPIDS1,2, Xiaotian Zheng, MD PhD3,4, Kathleen Todd, BS, MT(ASCP)3 and Dale N. Gerding, MD, FIDSA5,6, (1)Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (2)Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, (3)Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (4)Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, (5)Loyola University Chicago Stritch School of Medicine, Hines, IL, (6)Edward Hines Jr. VA Hospital, Hines, IL

    Disclosures:

    L. Kociolek, Merck: Grant Investigator , Grant recipient
    Cubist: Grant Investigator , Grant recipient
    Alere: Investigator , Research support

    S. Patel, Cubist: Grant Investigator , Grant recipient

    S. Shulman, None

    X. Zheng, None

    K. Todd, None

    D. N. Gerding, Sanofi Pasteur: Board Member , Consulting fee
    Actelion: Board Member , Consulting fee
    Merck: Board Member , Consulting fee
    Rebiotix: Board Member , Consulting fee
    Pfizer: Consultant , Consulting fee
    MedImmune: Consultant , Consulting fee
    DaVoltera: Consultant , Consulting fee
    Summit: Consultant , Consulting fee
    Viropharma/Shire: Consultant , Consulting fee

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