title: Epidemiology and risk factors for Clostridium difficile infection in children.
abstract: BACKGROUND
  Pediatric Clostridium difficile infection (CDI)-related hospitalizations are increasing. We sought to describe the epidemiology of pediatric CDI at a quaternary care hospital.
  
  
  METHODS
  Nested case-control study within a cohort of children <18 years tested for C. difficile between January and August 2008. The study included patients who were ≥ 1 year with a positive test and diarrhea; those without diarrhea (ie, presumed colonization) were excluded. Two unmatched controls per case were randomly selected from patients ≥ 1 year with a negative test. Potential predictors of CDI included age, gender, comorbidities, prior hospitalization, receipt of C. difficile-active antibiotics in the prior 24 hours, and recent (≤ 4 weeks) exposure to antibiotics or acid-blocking medications. Multivariate logistic regression models were created to identify independent predictors of CDI.
  
  
  RESULTS
  Of 1891 tests performed, 263 (14%) were positive in 181 children. Ninety-five patients ≥ 1 year with CDI were compared with 238 controls. In multivariate analyses, predictors of CDI included solid organ transplant (odds ratio [OR], 8.09; 95% confidence interval [CI], 2.10-31.12), lack of prior hospitalization (OR, 8.43; 95% CI, 4.39-16.20), presence of gastrostomy or jejunostomy (G or J) tube (OR, 3.32; 95% CI 1.71-6.42), and receipt of fluoroquinolones (OR, 17.04; 95% CI, 5.86-49.54) or nonquinolone antibiotics (OR, 2.23; 95% CI, 1.18-4.20) in the past 4 weeks. Receipt of C. difficile-active antibiotics within 24 hours before testing was associated with a lower odds of CDI (OR, 0.22; 95% CI, 0.09-0.58).
  
  
  CONCLUSIONS
  Recent antibiotic exposure and certain comorbid conditions (solid organ transplant, presence of a gastrostomy or jejunostomy tube) were associated with CDI. Diagnostic testing has less utility in patients being treated with C. difficile-active antibiotics.
authors.affiliation: Division of Infectious Diseases, Children's Hospital Boston, Boston, MA 02115, USA. thomas.sandora@childrens.harvard.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
authors.forename: Monica
authors.initials: M
authors.lastname: Fung
authors.forename: Kathleen
authors.initials: K
authors.lastname: Flaherty
authors.forename: Laura
authors.initials: L
authors.lastname: Helsing
authors.forename: Patricia
authors.initials: P
authors.lastname: Scanlon
authors.forename: Gail
authors.initials: G
authors.lastname: Potter-Bynoe
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Gidengil
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents