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Risk Factors for Community-Associated Clostridium difficile Infection in Children
Daniel J Adams1, Matthew D Eberly2, Michael Rajnik2
1Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, VA; Department of Pediatrics, Uniformed Services University, Bethesda, MD.
Insights
Pediatric community-associated Clostridium difficile infections (CA-CDI) are linked to common antibiotic use, proton pump inhibitors, and healthcare exposures. Limiting these exposures may help prevent CA-CDI in children.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Epidemiology
Background:
- Community-associated Clostridium difficile infections (CA-CDI) are a growing concern in pediatric populations.
- Understanding associated risk factors is crucial for effective prevention strategies.
Purpose of the Study:
- To identify medications and other exposures linked to pediatric CA-CDI.
- To inform clinical practice and public health interventions for CA-CDI prevention.
Main Methods:
- A case-control study was conducted using US military health system data from 2001-2013.
- 1331 pediatric CA-CDI cases were matched with 3993 controls.
- Medication exposures (fluoroquinolones, clindamycin, cephalosporins, PPIs) and healthcare/household exposures were analyzed.
Main Results:
- Strong associations were found between CA-CDI and exposure to fluoroquinolones, clindamycin, third-generation cephalosporins, and proton pump inhibitors.
- Multiple antibiotic class exposure, outpatient healthcare visits, and family member CDI also increased CA-CDI risk.
Conclusions:
- Pediatric CA-CDI is associated with frequently prescribed medications and environmental exposures.
- Judicious antibiotic use and infection control in outpatient settings and households are recommended.
Objective:
To characterize the medication and other exposures associated with pediatric community-associated Clostridium difficile infections (CA-CDIs).
Study Design:
We performed a case-control study using billing records from the US military health system database. CA-CDI cases included children 1-18 years of age with an outpatient International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for Clostridium difficile infection (CDI) from 2001 to 2013. Each case was matched to 3 controls without CDI by age and sex. Children hospitalized at any time before their CDI were excluded. Outpatient pharmacy records were used to identify medication exposures in the preceding 12 weeks. In addition, we evaluated recent outpatient healthcare exposure, exposure to a sibling younger than 1 year of age, or to a family member with CDI.
Results:
A total of 1331 children with CA-CDI were identified and 3993 controls were matched successfully. Recent exposure to fluoroquinolones, clindamycin (OR 73.00; 95% CI 13.85-384.68), third-generation cephalosporins (OR 16.32; 95% CI 9.11-29.26), proton pump inhibitors (OR 8.17; 95% CI 2.35-28.38), and to multiple classes of antibiotics, each was associated strongly the subsequent diagnosis of CA-CDI. Recent exposure to outpatient healthcare clinics (OR 1.35; 95% CI 1.31-1.39) or to a family member with CDI also was associated with CA-CDI.
Conclusions:
CA-CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.