title: Clostridium difficile infection among children across diverse US geographic locations.
abstract: OBJECTIVE
  Little is known about the epidemiology of Clostridium difficile infection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups.
  
  
  METHODS
  Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010-2011 were used to identify cases (ie, residents with C difficile-positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years.
  
  
  RESULTS
  Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100,000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks.
  
  
  CONCLUSIONS
  Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases.
authors.forename: Joyanna M
authors.initials: JM
authors.lastname: Wendt
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Cohen
authors.forename: Yi
authors.initials: Y
authors.lastname: Mu
authors.forename: Ghinwa K
authors.initials: GK
authors.lastname: Dumyati
authors.forename: John R
authors.initials: JR
authors.lastname: Dunn
authors.forename: Stacy M
authors.initials: SM
authors.lastname: Holzbauer
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Winston
authors.forename: Helen L
authors.initials: HL
authors.lastname: Johnston
authors.forename: James I
authors.initials: JI
authors.lastname: Meek
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Wilson
authors.forename: Erin C
authors.initials: EC
authors.lastname: Phipps
authors.forename: Zintars G
authors.initials: ZG
authors.lastname: Beldavs
authors.forename: Dale N
authors.initials: DN
authors.lastname: Gerding
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
authors.forename: Carolyn V
authors.initials: CV
authors.lastname: Gould
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
mesh_terms: D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D014481:United States / Q000453:epidemiology
keywords: Clostridium difficile; antimicrobial stewardship; community-associated; pediatric