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Published on: December 10, 2016
Clostridium difficile infection in hospitalized children in the United States
Cade M Nylund1, Anthony Goudie, Jose M Garza
1Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. cade.nylund@usuhs.mil
Insights
Clostridium difficile infection (CDI) cases are rising in hospitalized children, leading to longer stays and higher costs. However, the severity of CDI in children has not increased, unlike in adults.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Public Health Surveillance
Background:
- Clostridium difficile infection (CDI) is a significant healthcare-associated infection.
- Understanding trends and risk factors for CDI in pediatric populations is crucial for effective management.
Purpose of the Study:
- To analyze the incidence trends of CDI in hospitalized children in the U.S. from 1997 to 2006.
- To assess the severity and identify risk factors associated with pediatric CDI.
Main Methods:
- Retrospective cohort study utilizing the Healthcare Cost and Utilization Project Kids' Inpatient Database.
- Analysis of a nationally weighted sample of over 10 million pediatric hospital discharges across four triennial periods (1997, 2000, 2003, 2006).
- Outcomes measured included length of hospital stay, hospitalization charges, colectomy rates, and mortality.
Main Results:
- A significant increasing trend in CDI cases was observed, nearly doubling from 3565 in 1997 to 7779 in 2006.
- Patients with CDI experienced increased risks of death (OR, 1.20), colectomy (OR, 1.36), longer hospital stays (OR, 4.34), and higher charges (OR, 2.12).
- No increasing trend in CDI severity (death, colectomy, length of stay, charges) was found over the study period. Inflammatory bowel disease (OR, 11.42) and conditions requiring antibiotics were key risk factors.
Conclusions:
- CDI is increasingly prevalent among hospitalized children, significantly impacting healthcare utilization.
- Unlike adults, the severity of CDI in children has not trended upward.
- Children with inflammatory bowel disease, immunosuppression, or those requiring antibiotics are at elevated risk for CDI.
Objectives:
To evaluate the trend in Clostridium difficile infection (CDI) among hospitalized children in the United States and to evaluate the severity of and risk factors associated with these cases of CDI.
Design:
A retrospective cohort study using the triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 1997, 2000, 2003, and 2006.
Setting:
Hospitalized children in the United States.
Participants:
A nationally weighted number of patients (10 474 454) discharged from the hospital, 21 274 of whom had CDI.
Main Exposure:
Discharge diagnosis of CDI.
Main Outcome Measures:
Trend in cases of CDI; effect and severity were measured by length of hospital stay, hospitalization charges, colectomy rate, and death rate.
Results:
There was an increasing trend in cases of CDI, from 3565 cases in 1997 to 7779 cases in 2006 (P < .001). Patients with CDI had an increased risk of death (adjusted odds ratio [OR], 1.20; 95% confidence interval [95% CI], 1.01-1.43), colectomy (adjusted OR, 1.36; 95% CI, 1.04-1.79), a longer length of hospital stay (adjusted OR, 4.34; 95% CI, 3.97-4.83), and higher hospitalization charges (adjusted OR, 2.12; 95% CI, 1.98-2.26). There was no trend in death, colectomy, length of hospital stay, or hospitalization charges during the 4 time periods (ie, 1997, 2000, 2003, and 2006). The risk of comorbid diagnoses associated with CDI included inflammatory bowel disease, with an OR of 11.42 (95% CI, 10.16-12.83), and other comorbid diagnoses associated with immunosuppression or antibiotic administration.
Conclusions:
There is an increasing trend in CDI among hospitalized children, and this disease is having a significant effect on these children. In contrast to adults, there is no increasing trend in the severity of CDI in children. Children with medical conditions (including inflammatory bowel disease and immunosuppression) or conditions requiring antibiotic administration are at high risk of CDI.
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