title: Clostridium difficile in the Pediatric Population of Monroe County, New York.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) incidence in hospitalized children has increased over the past decade and disease has been reported in the community. Therefore, population surveillance that includes nonhospitalized cases is important to accurately estimate the burden of CDI in children. We describe the epidemiology of CDI in the pediatric population of Monroe County, New York.
  
  
  METHODS
  Active, laboratory, and population-based surveillance for CDI has been ongoing in Monroe County through the Emerging Infections Program of the Centers for Disease Control and Prevention since 2010. Infants less than 12 months of age are excluded.
  
  
  RESULTS
  In 2010, the incidence of CDI in the pediatric population was 33.8 per 100 000 population, which increased to 45.8 in 2011and remained stable in 2012. Seventy-one percent of the CDI cases were community-associated, 60% had an underlying medical condition, and 71% received antibiotics before their illness. The North American pulsed-field gel electrophoresis type 1 (NAP1) epidemic strain was identified in 27% of cultured stool specimens.
  
  
  CONCLUSIONS
  Clostridium difficile infection has emerged as a disease affecting children in both the community and hospital settings, with a higher proportion of community illness in our population. The majority of children with CDI had chronic underlying conditions and prior antibiotic exposure. To prevent CDI in this population, the judicious use of antibiotics, especially in the outpatient setting, may be the best strategy. Further population-based studies are warranted to determine preventable risk factors for CDI in the pediatric population.
authors.affiliation: Divison of Infectious Diseases, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rhee
authors.affiliation: Center for Community Health, University of Rochester, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tsay
authors.affiliation: Center for Community Health, University of Rochester, New York.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Nelson
authors.affiliation: Department of Public Health Sciences, University of Rochester, New York.
authors.forename: Edwin
authors.initials: E
authors.lastname: van Wijngaarden
authors.affiliation: Center for Community Health, University of Rochester, New York.
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
keywords: Clostridium difficile; children; pediatric; population surveillance.