title: Risk Factors for Hospital-acquired Clostridium difficile Infection Among Pediatric Patients With Cancer.
abstract: Hospital-acquired Clostridium difficile infection (CDI) may cause life-threatening colitis for children with cancer, making identification of risk factors important. We described characteristics of pediatric cancer patients with primary and recurring CDI, and evaluated potential risk factors. Among 189 cancer patients, 51 cases (27%) of CDI and 94 matched controls of cancer patients without CDI were analyzed. Multivariable logistic regression was used to evaluate the association between CDI and several potential risk factors. Median age of CDI cases was lower (3.3 y; 0.60 to 16.2) than controls (7.7 y; 0.4 to 20.5). Median duration of neutropenia before CDI was longer for CDI cases (10.0 d; 0.0 to 30.0) compared with duration calculated from reference date in controls (6.0 d; 0.0 to 29.0). Multivariable analysis showed that older age was associated with reduced risk (≥7 vs. 0 to 3 y, odds ratio=0.11; 95% confidence interval, 0.02-0.54), and prolonged neutropenia was associated with increased risk (odds ratio=1.11; 95% confidence interval, 1.01-1.22). CDI recurred in 26% of cases. Younger age and prolonged neutropenia were risk factors for CDI in children with cancer. Increasing awareness to these risk factors will help to identify opportunities for CDI prevention in cancer patients.
authors.affiliation: *Department of Pediatrics, St. Luke's International Hospital, Chuo-ku, Tokyo †Pediatric Medical Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime ‡Center for Clinical Epidemiology §Research Center, St. Luke's International University, Chuo-ku, Tokyo, Japan.
authors.forename: Atsuro
authors.initials: A
authors.lastname: Daida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Ikuko
authors.initials: I
authors.lastname: Inai
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hasegawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Kevin Y
authors.initials: KY
authors.lastname: Urayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Manabe
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000209:etiology* / Q000821:virology; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications; D012307:Risk Factors; D055815:Young Adult