title: Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001-2006.
abstract: OBJECTIVE
  Clostridium difficile is the main cause of nosocomial and antibiotic-associated diarrhea in adults. Recently, the incidence and severity of C difficile-associated disease in adults have been increasing. Whether similar phenomena are occurring among children remains unknown. Our study describes the epidemiological features of C difficile-associated disease in hospitalized children.
  
  
  METHODS
  We conducted a retrospective cohort study of hospitalized children with C difficile-associated disease at 22 freestanding children's hospitals in the United States, from 2001 to 2006. Cases of C difficile-associated disease were defined as a hospitalized child with a discharge code for C difficile infection, a laboratory billing charge for a C difficile toxin assay, and receipt of antimicrobial therapy for C difficile-associated disease.
  
  
  RESULTS
  We identified 4895 patients with C difficile-associated disease. Over the study period, the annual incidence of C difficile-associated disease increased from 2.6 to 4.0 cases per 1000 admissions and from 4.4 to 6.5 cases per 10 000 patient-days. The median age of children with C difficile-associated disease was 4 years. Twenty-six percent of patients were <1 year of age. The majority of patients (67%) had underlying chronic medical conditions. The colectomy and all-cause mortality rates among children with C difficile-associated disease did not increase during the study period.
  
  
  CONCLUSIONS
  The annual incidence of C difficile-associated disease in hospitalized children increased significantly from 2001 to 2006. However, the rates of colectomy and in-hospital death have not increased in children with C difficile-associated disease as they have among adults. The risk factors and outcomes for children with C difficile-associated disease remain to be defined in future studies.
authors.affiliation: Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. kimj@email.chop.edu
authors.forename: Jason
authors.initials: J
authors.lastname: Kim
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Smathers
authors.forename: Priya
authors.initials: P
authors.lastname: Prasad
authors.forename: Kateri H
authors.initials: KH
authors.lastname: Leckerman
authors.forename: Susan
authors.initials: S
authors.lastname: Coffin
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014481:United States / Q000453:epidemiology