1279. Incidence of Pediatric Community Associated Clostridium Difficile Infection Following Common Antibotics
Session: Poster Abstract Session: HAI: C. difficile Epidemiology, Impact, and Testing
Friday, October 6, 2017
Room: Poster Hall CD
Background: As rates of pediatric community-associated (CA) Clostridium difficile infection (CDI) increase, additional research is needed to address rates of infection following common antibiotics.

Methods: This study was a retrospective review of the electronic health records of all children with stool specimens sent for C difficile from January 1st 2012 – December 31st2016 at Kaiser Permanente Northern California. Children with clinical symptoms consistent with CDI, confirmatory laboratory testing, no other identified causes of diarrhea, and community associated disease were defined as cases. Using outpatient and ED antibiotic prescription records for children, incidence rates were calculated for subsequent CA CDI for the most commonly prescribed antibiotics.

Results:Of 507 primary CDI cases in our cohort, 327 had any antibiotic use 2012-2015. There were 205 primary CDI cases that were preceded by an antibiotic in the previous 1-365 days. Many of these patients had more than 1 antibiotic in the preceding year.

Of those, rates of CA CDI were uncommon following common antibiotics. (Table) The highest rate of CA CDI followed ceftriaxone, cefdinir, ciprofloxacin and augmentin. The lowest rates were seen following penicillin, doxycycline and azithromycin. Ninety-three percent of the antibiotic prescriptions were in outpatients, 7% in inpatients.

Table: Incidence rate of CA CDI following common antibiotics

Drug

# Rx

CA CDI cases with at least 1 prescription in last year

Rate

Rate per 100,000

Amoxicillin

86,180

38

0.0004

44

Augmentin

49,361

35

0.0007

71

Azithromycin

160,846

45

0.0003

28

Cefdinir

37,284

36

0.0010

97

Ceftriaxone

10,616

11

0.0010

104

Cefuroxime

852

1

0.0012

117

Cephalexin

124,293

55

0.0004

44

Ciprofloxacin

10,088

9

0.0009

89

Clindamycin

79,884

36

0.0005

45

Doxycycline

37,086

8

0.0002

22

Levofloxacin

687

1

0.0015

146

Penicillin

19,488

4

0.0002

21

Rifampin

486

0

0

0

Sulfamethoxazole TMP

49,918

34

0.0007

68

Tetracycline

6

0

0

0

Total

667,075

205

0.0003

31

Conclusion: As rates of CA CDI increase, clinicians should be aware of rates of infection following administration of common antibiotics. The most common antibiotics to cause CA CDI were third generation cephalosporins (ceftriaxone and cefdinir) and ciprofloxacin.

Margot Miranda Katz, none, Colby College, San Rafael, CA, Deepika Parmar, MD, Pediatrics, Kaiser Permanente Northern California, Oakland, CA, Rebecca Dang, MD, Pediatrics, Kaiser Permanente Northern California, Oakland, Oakland, CA, Amy Alabaster, PhD, Kaiser Permanente Division of Research, Oakland, CA and Tara Greenhow, MD, Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, CA; Pediatric Infectious Diseases, Kaiser Permanente Northern California, San Francisco, CA

Disclosures:

M. Miranda Katz, None

D. Parmar, None

R. Dang, None

A. Alabaster, None

T. Greenhow, None

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