title: A hospital-based study of the clinical characteristics of Clostridium difficile infection in children.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is an increasingly important cause of morbidity in hospitalized children. We describe the recent epidemiology of pediatric CDI at a children's hospital, compare community-associated (CA) and hospital-associated (HA) infections and identify risk factors for severe disease.
  
  
  METHODS
  Children with CDI at Texas Children's Hospital were identified from February 1, 2011, to October 31, 2011. Severe CDI was defined as the presence of a CDI-related complication or ≥2 clinical features: fever, bloody stools, leukocytosis, hypoalbuminemia or elevated creatinine. Standard epidemiologic definitions were used.
  
  
  RESULTS
  One-hundred and nine unique patients 1-21 years of age with CDI were identified throughout the study period. The proportions of CA-CDI (41%) and HA-CDI (46%) were similar, whereas community-onset indeterminate CDI (13%) was less common. Children with malignancy or solid organ transplantation were more likely to have HA-CDI. Conversely, all children with inflammatory bowel disease had CA-CDI. Twenty-three patients (21%) met criteria for severe disease and 8 experienced a CDI-related complication, including 1 death attributable to CDI. On multivariate analysis, the presence of a gastrostomy tube (adjusted odds ratio: 3.09; 95% confidence interval: 1.07-8.94) and having community-onset indeterminate disease (adjusted odds ratio: 4.62; 95% confidence interval: 1.28-16.67) were found to be associated with severe CDI.
  
  
  CONCLUSIONS
  A substantial proportion of pediatric CDI is CA and there are clinical differences between children with CA-CDI and HA-CDI. Children with CDI frequently experience severe disease, whereas complications are uncommon. Early identification and treatment of CDI should be pursued in children with gastrostomy tube and recent hospitalization.
authors.affiliation: From the *Department of Pediatrics; †Department of Internal Medicine, Baylor College of Medicine; ‡Center for Infectious Diseases, University of Texas School of Public Health; and §St. Luke's Medical Center, Houston, TX.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Crews
authors.forename: Hoonmo L
authors.initials: HL
authors.lastname: Koo
authors.forename: Zhi-Dong
authors.initials: ZD
authors.lastname: Jiang
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Starke
authors.forename: Herbert L
authors.initials: HL
authors.lastname: DuPont
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005774:Gastrostomy; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology; D007441:Intubation, Gastrointestinal; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D016377:Organ Transplantation; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas; D055815:Young Adult