title: Outcomes in children with Clostridium difficile infection: results from a nationwide survey.
abstract: OBJECTIVE
  Hospital- and population-based studies demonstrate an increasing incidence of Clostridium difficile infection (CDI) in adults and children; although pediatric CDI outcomes are incompletely understood. We analysed United States National Hospital Discharge Survey (NHDS) data to study CDI in hospitalized children.
  
  
  METHODS
  NHDS data for 2005-2009 (demographics, diagnoses and discharge status) were obtained; cases and comorbidities were identified using ICD-9 codes. Weighted univariate and multivariate analyses were performed to ascertain incidence of CDI; associations between CDI and outcomes [length of stay (LOS), colectomy, all-cause in-hospital mortality and discharge to a care facility (DTCF)].
  
  
  RESULTS
  Of an estimated 13.8 million pediatric inpatients; 46 176 had CDI; median age was 3 years; overall incidence was 33.5/10 000 hospitalizations. The annual frequency of CDI did not vary from 2005 to 2009 (0.24-0.43%; P = 0.64). On univariate analyses, children with CDI had a longer median LOS (6 vs 2 days), higher rates of colectomy [odds ratio (OR) 2.0; 95% confidence interval (CI) 1.7-2.4], mortality (OR 2.5; 95% CI 2.3-2.7), and DTCF (OR 1.6; 95% CI 1.6-1.7) (all P < 0.0001). After adjusting for age, sex and comorbidities, CDI was an independent and the strongest predictor of increased LOS (adjusted mean difference, 6.4 days; 95% CI 5.4-7.4), higher rates of colectomy (OR 2.1; 95% CI 1.8-2.5), mortality (OR 2.3; 95% CI 2.2-2.5), and DTCF (OR 1.7; 95% CI 1.6-1.8) (all P < 0.0001). On excluding infants from the analysis, children with CDI had higher rates of mortality, DTCF and longer LOS than children without CDI.
  
  
  CONCLUSIONS
  Despite increased awareness and advancements in management, CDI remains a significant problem and is associated with increased LOS, colectomy, in-hospital mortality and DTCF in hospitalized children.
authors.affiliation: Divisions of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.|Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.affiliation: Divisions of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA khanna.sahil@mayo.edu.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
keywords: Clostridium difficile infection; children; epidemiology; outcomes; pediatric