title: Morbidity and mortality in severely burned children with Clostridium difficile-associated diarrhea.
abstract: Clostridium difficile is a key culprit underlying nosocomial infectious diarrhea. We investigated the effect of C difficile-associated diarrhea (CDAD) on morbidity and mortality in severely burned children and CDAD risk factors.
  
  
  
  After review of 2,840 records, 288 pediatric burn patients were identified as having stool output of >10 mL•kg(-1)•min(-1) for ≥2 successive days and had stool samples immunoassayed for toxins A and B. A case control analysis was performed by matching cases to controls via logistic regression and propensity scores so that age, admission time, and time of occurrence could be controlled; the endpoints were mortality and hospitalization time.
  
  
  
  Eighteen patients tested positive for C difficile toxins (median age, 4 years; mean total body surface area burned, 59%). In the CDAD group, unadjusted in-hospital mortality was 28% (odds ratio, 5.4; 95% CI, 1.7-16.7; P = .01). Hospitalization averaged 48 days in the CDAD group and 38 days in the non-CDAD group (P = .24). Duration of stay per percent total body surface area burned was greater in the CDAD group (0.82 ± 0.4 vs 0.60 ± 0.4; P = .03), as were prolonged bouts of diarrhea complicated by acidosis (13 ± 16 vs 4 ± 5 days; P < .005). Of the 18 possible risk factors evaluated, inhalation injury diagnosed at admission occurred more often in CDAD patients than matched controls (59% vs 31%; P = .04).
  
  
  
  CDAD during hospitalization is associated with greater mortality after burns. Inhalation injury increases the likelihood of C difficile infection. Whether C difficile infection is an indication of greater illness among certain burned patients is unknown.
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.|Sealy Center for Molecular Medicine and the Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Celeste C
authors.initials: CC
authors.lastname: Finnerty
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.|Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.|Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Jong O
authors.initials: JO
authors.lastname: Lee
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.|Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Noe A
authors.initials: NA
authors.lastname: Rodriguez
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.
authors.forename: Iman H
authors.initials: IH
authors.lastname: Al-Haj
authors.affiliation: Shriners Hospitals for Children, Galveston, Texas.|Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Paul
authors.initials: P
authors.lastname: Wurzer
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Brendan R
authors.initials: BR
authors.lastname: Calhoun
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D002056:Burns / Q000150:complications* / Q000401:mortality*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D003967:Diarrhea / Q000382:microbiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male