Clostridium difficile infection in the pediatric surgery population.
OBJECTIVE
The incidence of Clostridium difficile-associated disease (CDAD) in the adult population doubled in the past decade, with increasing morbidity and mortality; however, little research has been performed in the pediatric population. We characterized C difficile infection in the pediatric population, with emphasis on the surgical population.


METHODS
At a university-based children's hospital, we reviewed 231 patient (birth to 18 years of age) records containing a diagnosis of CDAD between January 1, 2002, and December 31, 2008.


RESULTS
Clostridium difficile-associated disease incidence increased from 250 per 100,000 hospitalizations in 2002 to 580 per 100,000 hospitalizations in 2008. No fatalities or surgical interventions were attributable to CDAD. Eighty-seven percent of patients received antibiotics within 2 months of diagnosis. Fifty-two percent of patients underwent operative intervention within 2 months of diagnosis; of these, 89% percent received previous antibiotic therapy and 57% were immunosuppressed. The most common antecedent procedures were bone marrow biopsy and line placement for myelodysplastic diseases (40%), followed by renal transplant (11%).


CONCLUSIONS
Pediatric CDAD incidence doubled during the study period but was not associated with death or operative intervention. A substantial number of CDAD cases were associated with previous operative procedures, particularly in immunosuppressed patients and those who received prior antibiotics.
Department of Surgery, University of Minnesota, Amplatz Children's Hospital, Minneapolis, MN 55455, USA. Kathryn.chen@gmail.com
Kathryn T
KT
Chen
Daniel J
DJ
Stephens
Eric
E
Anderson
Robert
R
Acton
Daniel
D
Saltzman
Donavon J
DJ
Hess
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents