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Updated: Jan 28, 2026

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Risk factors for Clostridium difficile infection in pediatric inpatients: A meta-analysis and systematic review

Scott Anjewierden1, Zheyi Han1, Charles B Foster2

  • 1Cleveland Clinic Lerner College of Medicine,Case Western Reserve University,Cleveland, Ohio,USA.

Infection Control and Hospital Epidemiology
|March 8, 2019
PubMed

Insights

Prior antibiotic exposure and proton pump inhibitor (PPI) use are risk factors for Clostridioides difficile infection (CDI) in hospitalized children. Careful use of these medications may reduce CDI risk in pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Gastroenterology
  • Pharmacology

Background:

  • Clostridioides difficile infection (CDI) is a significant cause of hospital-acquired infections in children.
  • Identifying risk factors is crucial for preventing CDI in pediatric inpatients.

Purpose of the Study:

  • To systematically review and meta-analyze observational studies identifying risk factors for CDI in hospitalized pediatric patients.
  • To summarize the evidence on the association between prior antibiotic exposure, proton pump inhibitor (PPI) use, and other factors with pediatric CDI.

Main Methods:

  • Systematic search of major biomedical databases (MEDLINE, Web of Science, Scopus, EMBASE) from 1975 to 2017.
  • Inclusion of studies evaluating risk factors for CDI in pediatric inpatients.
  • Meta-analysis of data from 14 eligible studies involving over 10 million children.

Main Results:

  • Prior antibiotic exposure (OR, 2.14) and proton pump inhibitor (PPI) use (OR, 1.33) were associated with an increased risk of CDI in children.
  • Subgroup analysis of adjusted studies indicated prior antibiotic exposure was not a significant risk factor.
  • H2 receptor antagonist use and female gender were not significant risk factors for CDI.

Conclusions:

  • Combined analysis suggests prior antibiotic exposure is an important risk factor for pediatric CDI, though not significant in adjusted studies.
  • Proton pump inhibitor use is associated with an increased risk of CDI in children.
  • Judicious use of antibiotics and PPIs may help mitigate CDI risk in pediatric populations.
Abstract

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