title: Risk factors for in-hospital mortality among a cohort of children with Clostridium difficile infection.
abstract: OBJECTIVE
  The incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI.
  
  
  METHODS
  A multicenter cohort of children with CDI, aged 1-18 years, was established among children hospitalized at 41 freestanding children's hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model.
  
  
  RESULTS
  We identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2-13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7-20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40-3.77)], underlying malignancy [3.57 (2.36-5.40)], cardiovascular disease [2.06 (1.28-3.30)], hematologic/immunologic condition [1.89 (1.05-3.39)], gastric acid suppression [2.70 (1.43-5.08)], and presence of >1 severity of illness marker [3.88 (2.44-6.19)].
  
  
  CONCLUSIONS
  Patients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies.
authors.affiliation: 1Division of Infectious Disease,The Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Neika
authors.initials: N
authors.lastname: Vendetti
authors.affiliation: 1Division of Infectious Disease,The Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.affiliation: 1Division of Infectious Disease,The Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: 1Division of Infectious Disease,The Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Julia Shaklee
authors.initials: JS
authors.lastname: Sammons
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors