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Predictors of Clostridium difficile infections in hospitalized children

Authors

  • Waheeda Samady MD,

    Corresponding author
    1. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    2. Division of Hospital-Based Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
    • Address for correspondence and reprint requests: Waheeda Samady, MD, Lurie Children's Hospital, 225 East Chicago Ave., Box #55, Chicago, IL 60611; Telephone: 858-254-6988; Fax: 312-227-9418; E-mail: wsamady@luriechildrens.org

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  • Ruth Bush PhD,

    1. Research Department, Rady Children's Hospital San Diego, San Diego, California
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  • Alice Pong MD,

    1. Department of Pediatrics, University of California San Diego, San Diego, California
    2. Division of Infectious Disease, Rady Children's Hospital San Diego, San Diego, California
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  • Allyson Andrews MPH,

    1. Department of Quality Management, Rady Children's Hospital San Diego, San Diego, California
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  • Erin Stucky Fisher MD

    1. Department of Pediatrics, University of California San Diego, San Diego, California
    2. Division of Hospital Medicine, Rady Children's Hosptial San Diego, San Diego, California
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Abstract

BACKGROUND

Recent studies report an increasing incidence of Clostridium difficile infections (CDIs) in children and suggest that CDIs may occur outside known populations at risk.

OBJECTIVE

To identify clinical factors associated with CDI in a hospitalized pediatric population.

METHODS

A retrospective case-control study was conducted with C difficile cases (CD) and controls (CTLs) in hospitalized children over a 2-year period. CDs (N = 134) and 2:1 age-matched CTLs (N = 274) with diarrheal illness were evaluated.

RESULTS

CDs and CTLs were similar in gender and race. Watery diarrhea was the most common type of diarrhea in CDs and CTLs. Immunodeficiency (46% vs 6%; P < 0.001), gastrointestinal (GI) disease (31% vs 18%; P = 0.005), and proton pump inhibitor (PPI) use (22% vs 7%; P < 0.001) were more frequent in CDs. Of CDs, 30% were defined as community acquired. Bloody diarrhea was more frequent in community-acquired CD (28% vs 4% P < 0.001); however, other clinical variables were not statistically different. No antibiotic exposure, recent hospitalization, prolonged hospitalization, or past history of CDI existed in 8% of CDs. Multivariate logistic regression demonstrated that antibiotic use (odds ratio [OR]: 2.80, P = 0.001), recent hospitalization (OR: 2.33, P = 0.007), and immunodeficiency (OR: 6.02, P < 0.001) were significantly associated with cases when controlling for PPI use, having GI disease, and history of abdominal surgery.

CONCLUSIONS

Clinical history is of greater value than symptoms in distinguishing CD, with immunodeficiency having the strongest association. An important percentage of CDs did not have any risk factors, confirming concerns that CDIs do occur in otherwise low-risk pediatric populations Journal of Hospital Medicine 2014;9:94–98. © 2013 Society of Hospital Medicine

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