Risk factors and outcomes associated with severe clostridium difficile infection in children.
BACKGROUND
The incidence and severity of Clostridium difficile infection (CDI) is increasing among adults; however, little is known about the epidemiology of CDI among children.


METHODS
We conducted a nested case-control study to identify the risk factors for and a prospective cohort study to determine the outcomes associated with severe CDI at 2 children's hospitals. Severe CDI was defined as CDI and at least 1 complication or ≥2 laboratory or clinical indicators consistent with severe disease. Studied outcomes included relapse, treatment failure, and CDI-related complications. Isolates were tested to determine North American pulsed-field gel electrophoresis type 1 lineage.


RESULTS
We analyzed 82 patients with CDI, of whom 48 had severe disease. Median age in years was 5.93 (1.78-12.16) and 1.83 (0.67-8.1) in subjects with severe and nonsevere CDI, respectively (P = 0.012). All patients with malignancy and CDI had severe disease. Nine subjects (11%) had North American pulsed-field gel electrophoresis type 1 isolates. Risk factors for severe disease included age (adjusted odds ratio [95% confidence interval]: 1.12 [1.02, 1.24]) and receipt of 3 antibiotic classes in the 30 days before infection (3.95 [1.19, 13.11]). If infants less than 1 year of age were excluded, only receipt of 3 antibiotic classes remained significantly associated with severe disease. Neither the rate of relapse nor treatment failure differed significantly between patients with severe and nonsevere CDI. There was 1 death.


CONCLUSIONS
Increasing age and exposure to multiple antibiotic classes were risk factors for severe CDI. Although most patients studied had severe disease, complications were infrequent. Relapse rates were similar to those reported in adults.
Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA 19104–4318, USA. kimj@email.chop.edu
Jason
J
Kim
Julia F
JF
Shaklee
Sarah
S
Smathers
Priya
P
Prasad
Lindsey
L
Asti
Joan
J
Zoltanski
Michael
M
Dul
Michelle
M
Nerandzic
Susan E
SE
Coffin
Philip
P
Toltzis
Theoklis
T
Zaoutis
D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D058889:Molecular Typing; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D017211:Treatment Failure