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Clostridium difficile Infection in Children: Epidemiology and Trend in a Swedish Tertiary Care Hospital
Lovisa Malmqvist1, Måns Ullberg2, Ida Hed Myrberg3
1From the Paediatric Oncology Department, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Insights
Pediatric Clostridium difficile infection (CDI) showed an increasing trend in Sweden from 2010-2018, despite national reports of decreasing incidence. This infection was linked to underlying health issues and frequent recurrences in children.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Global studies indicate a rise in pediatric Clostridium difficile infection (CDI).
- Swedish Public Health Agency data suggests a decline in overall CDI incidence since 2007.
- This study focuses on pediatric CDI epidemiology in Sweden.
Purpose of the Study:
- To analyze the incidence and trends of Clostridium difficile infection (CDI) in pediatric patients.
- To investigate the characteristics of new and recurrent CDI episodes in children.
- To determine the association of CDI with underlying medical conditions in pediatric populations.
Main Methods:
- Retrospective chart review of pediatric patients (1 to <19 years) with Clostridium difficile toxin B.
- Data collected from July 2010 to June 2018 at Karolinska University Hospital.
- Classification of CDI episodes as new or recurrent, and hospital-associated (HA-CDI) or community-associated (CA-CDI).
Main Results:
- A total of 328 positive tests in 206 pediatric patients were analyzed.
- The mean infection rate was 8.5 per 100,000 children.
- An increasing trend in CDI rates was observed from 2010-2018, though not statistically significant. 72.6% of new episodes were HA-CDI.
Conclusions:
- Pediatric CDI in Sweden exhibited an increasing trend between 2010 and 2018, but lacked statistical significance.
- Clostridium difficile infection in children was frequently associated with comorbid conditions.
- Recurrent CDI episodes were common, highlighting the persistent challenge of managing this infection in pediatric populations.
Background:
Several studies have shown an increasing trend in pediatric Clostridium difficile infection (CDI). However, the Public Health Agency in Sweden reports a decreasing incidence of CDI in the Swedish population since 2007. The main aim of this study is to analyze the epidemiology of CDI in children.
Methods:
Retrospective chart-review of patients 1 to <19 years old, positive for Clostridium difficile toxin B, tested at Karolinska University Hospital Units, over the time period from July 1, 2010 to June 30, 2018. Episodes were classified as recurrences (≥2 weeks, ≤8 weeks from previous episode) or new episodes (>8 weeks from previous episode). New episodes were classified as hospital- (HA-CDI) or community-associated (CA-CDI). Annual infection rates/100,000 children in the catchment area were calculated.
Results:
Three hundred twenty-eight positive tests in 206 patients were included of which 259 (79.0%) tests were new episodes and 69 (21.0%) recurrences. In 63/206 (30.6%) children, >1 episode of CDI was recorded. The mean infection rate was 8.5/100,000 children. There was an overall increasing trend in CDI-rate July 2010-June 2018, however not statistically significant (P = 0.061) nor for the incidence in HA-CDI (P = 0.720) or CA-CDI (P = 0.179). Underlying medical conditions were present in 226/259 (87.3%) new episodes of which the most common was malignancy. Of the new episodes, 188/259 (72.6%) were HA-CDI and 46/259 (17.8%) were CA-CDI.
Conclusions:
There was an increasing trend in CDI in children in Sweden from 2010 to 2018, although not statistically significant. CDI was associated with comorbid conditions and repeated episodes were common.
