Methods: A retrospective study was conducted between Nov. 1, 2013 and Oct. 31, 2016 at Arkansas Children’s Hospital. Children ages 1 – 18 years with a positive C. diff PCR test and ≥3 loose stools documented were included. Cases were excluded if previous positive PCR was within 60 days. Data collection included age, sex, encounter type (inpatient or outpatient), acid suppressing agents, previous antimicrobials within last 90 days and comorbidities including transplant, chronic pulmonary, hematology/oncology, and GI tract diseases. Statistical methods included descriptive analyses, χ2test, and Kruskal-Wallis test.
Results: A total of 139 cases of CDI among 123 patients were evaluated. Of these cases, the median (IQR) age is 8 years (3-13) with 77 (55.4%) being male and 86 (61.9%) of CDI cases identified inpatient of which 75 came from outpatient. Pediatric risk factors identified in C. diff cases included exposure to acid suppressing agents [61 (43.9%)] and antimicrobials [98 (70.5%)] with 90 (64.7%) having ≥1 comorbidities. Cases having ≥1 comorbidities were found to be associated with previous antacid exposure (p<0.0005) while antimicrobial(s) use was associated with CDI hospitalization (p=0.001). Similarly, exposure to either antacid suppression or antimicrobials or both with comorbidities were found to have a significant association (p<0.0005) and associated with CDI hospitalization (p=0.001).
Conclusion: Exposure to acid suppression in patients with comorbidities was associated with increased risk of CDI. Antimicrobial usage was associated with increased risk for hospitalization due to CDI. As pediatric outpatient antimicrobial stewardship evolves, improving CDI rates can center on improving antimicrobial and acid suppressive agents usage.
H. A. Huynh,
H. D. Maples, None