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Risk Factors for Recurrent Clostridium difficile Infection in Pediatric Inpatients
Elyse M Schwab1, Jacob Wilkes2, Kent Korgenski2
1Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, Utah;
Insights
Hospitalized children with Clostridium difficile infection (CDI) who have complex chronic conditions, malignancies, or receive non-CDI antibiotics face a higher risk of CDI recurrence. Reducing non-CDI antibiotic use may lower recurrence rates.
Area of Science:
- Infectious Diseases
- Pediatric Hospital Medicine
- Epidemiology
Background:
- Clostridium difficile infection (CDI) is a significant cause of hospital-acquired infections.
- Recurrent CDI poses a substantial clinical challenge, particularly in pediatric populations.
- Identifying risk factors for recurrent CDI is crucial for developing targeted interventions.
Purpose of the Study:
- To identify risk factors associated with recurrent Clostridium difficile infection (CDI) within 60 days of the initial episode in hospitalized children.
- To determine if these risk factors are amenable to clinical intervention.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) diagnosed with CDI between 2003 and 2010.
- Exclusion criteria included age <1 year and prior CDI within 60 days.
- Multivariable logistic regression analyzed predictors of recurrent CDI, including complex chronic conditions, malignancy, and antibiotic exposure.
Main Results:
- Out of 612 patients with incident CDI, 65 (10.6%) experienced recurrence.
- Patients with complex chronic conditions had a 4.0-fold increased risk of recurrence.
- Malignancy (2.3-fold increased risk) and receipt of non-CDI antibiotics during CDI treatment (2.8-fold increased risk) were significant predictors of recurrence.
Conclusions:
- Underlying comorbidities, malignancies, and non-CDI antibiotic use during CDI treatment are key risk factors for recurrence in children.
- Reducing unnecessary non-CDI antibiotic prescriptions could mitigate the risk of CDI recurrence.
- These findings highlight potential targets for intervention to prevent CDI recurrence in pediatric patients.
Objective:
The purpose of this study was to identify the risk factors during the incident Clostridium difficile infection (CDI) episode, associated with developing recurrent CDI within 60 days, among hospitalized children that may be amenable to intervention.
Methods:
This was a retrospective cohort study of pediatric patients hospitalized at a freestanding children's hospital from January 1, 2003, to December 31, 2010. Patients were eligible if they were <18 years of age at admission and had a new diagnosis of CDI. Patients <1 year of age and those with a history of CDI in the previous 60 days were excluded. Age, gender, race, complex chronic conditions, and other information were collected. Multivariable logistic regression was used to evaluate predictors of recurrent CDI.
Results:
During the study period, there were 612 unique patients with an incident CDI episode; 65 (10.6%) experienced at least 1 recurrence. Patients with any complex chronic condition were 4.0 (95% confidence interval [CI]: 1.2-13.9) times more likely to experience recurrence. Patients with a malignancy and those who received non-CDI antibiotics at any time during CDI treatment were 2.3 (95% CI: 1.3-4.0) and 2.8 (95% CI: 1.2-6.9) times more likely to experience recurrence, respectively.
Conclusions:
The presence of underlying comorbidities, malignancies, and treatment with non-CDI antibiotics during CDI treatment were the most important risk factors for recurrence. Efforts to reduce unnecessary courses of non-CDI antibiotics could lower the risk of CDI recurrence.
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