1303. Association of Acid Suppression and Antimicrobial Use with Clostridium difficile Infection in Children
Session: Poster Abstract Session: HAI: C. difficile Risk Assessment and Prevention
Friday, October 6, 2017
Room: Poster Hall CD
  • CDI-Poster-IDWeek2017-HHuynh.pdf (98.6 kB)
  • Background: Clostridium difficileinfections (CDIs) can cause severe diarrhea and be potentially life-threatening, especially in children. Possible risk factors include age, being immunocompromised, prior antibiotic exposure, use of antacids, and diseases that alter intestinal microbiota. Data in adults are vast while limited data is available in children. The objectives of this study are to identify pediatric risk factors and determine if an association between acid suppression and CDI’s in children exists.

    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.

    Hoang A. Huynh, PharmD, MBA1,2, Christy Wisdom, MSN, RN, CIC, LSSBB3 and Holly D. Maples, PharmD1,2, (1)Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, (2)Department of Pharmacy, Arkansas Children's Hospital, Little Rock, AR, (3)Infection Prevention and Control Department, Arkansas Children's Hospital, Little Rock, AR


    H. A. Huynh, None

    C. Wisdom, None

    H. D. Maples, None

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