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Published on: December 8, 2014
Risk Factors for Hospital-acquired Clostridium difficile Infection Among Pediatric Patients With Cancer
Atsuro Daida1, Hiroki Yoshihara, Ikuko Inai
1*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.
Insights
Hospital-acquired Clostridium difficile infection (CDI) is a serious risk for children with cancer. Younger age and prolonged neutropenia are key risk factors for developing CDI in this vulnerable population.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Hospital-acquired Clostridium difficile infection (CDI) poses a significant threat, potentially leading to life-threatening colitis in pediatric cancer patients.
- Identifying risk factors for CDI in this immunocompromised population is crucial for effective prevention and management strategies.
Purpose of the Study:
- To characterize pediatric cancer patients experiencing primary and recurrent CDI.
- To evaluate potential risk factors associated with the development of CDI in this cohort.
Main Methods:
- A case-control study was conducted involving 189 pediatric cancer patients, with 51 diagnosed with CDI and 94 matched controls without CDI.
- Multivariable logistic regression analysis was employed to assess the association between CDI and various potential risk factors.
Main Results:
- CDI cases were younger (median age 3.3 years) compared to controls (median age 7.7 years).
- A longer duration of neutropenia preceding CDI diagnosis was observed in cases (10.0 days) versus controls (6.0 days).
- Older age (≥7 years) was associated with a reduced risk of CDI (OR=0.11), while prolonged neutropenia increased the risk (OR=1.11).
Conclusions:
- Younger age and prolonged neutropenia are significant risk factors for hospital-acquired Clostridium difficile infection in pediatric cancer patients.
- Enhanced awareness of these risk factors can guide targeted prevention efforts and improve outcomes for children undergoing cancer treatment.
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.
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