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Epidemiology and Risk Factors for Community Associated Clostridioides difficile in Children
Margot Miranda-Katz1, Deepika Parmar2, Rebecca Dang2
1Colby College, Waterville, ME.
Insights
Community-associated Clostridioides difficile infection (CDI) is increasing in children. Risk factors include non-Hispanic ethnicity, antibiotic use, and frequent healthcare visits, highlighting the need for better antibiotic stewardship.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Community-associated Clostridioides difficile infection (CDI) poses a growing threat to pediatric populations.
- Understanding the specific risk factors for pediatric community-acquired CDI is crucial for effective prevention and management strategies.
Purpose of the Study:
- To identify and assess the key risk factors associated with community-associated Clostridioides difficile infection (CDI) in children aged 1-17 years.
Main Methods:
- A retrospective case-control study was conducted using data from January 2012 to December 2016.
- Children with positive C. difficile tests (cases) were matched 1:1 with children with negative tests (controls) by age and specimen collection year.
- Inclusion criteria involved C. difficile testing in the community or within the first 48 hours of hospital admission, with no prior positive tests in the preceding 8 weeks and no other identified causes of diarrhea.
Main Results:
- The incidence of community-acquired CDI in children rose significantly from 9.6 to 16.9 cases per 100,000 children per year between 2012 and 2015.
- Identified risk factors for community-acquired CDI included non-Hispanic ethnicity, use of amoxicillin-clavulanate, cephalosporins, or clindamycin within 12 weeks, a prior positive C. difficile test within 6 months, and increased healthcare visits in the past year.
Conclusions:
- The increasing rates of community-acquired CDI in children necessitate enhanced antibiotic stewardship programs.
- Addressing healthcare disparities may also play a role in mitigating the burden of pediatric community-acquired CDI.
Objective:
To assess which risk factors are associated with community-associated Clostridioides difficile infection (CDI) in children.
Study Design:
This case control study was a retrospective review of all children 1-17 years of age with stool specimens sent for C difficile testing from January 1, 2012, to December 31, 2016. Cases and controls were children who had C difficile testing performed in the community or first 48 hours of hospital admission and >12 weeks after hospital discharge, with no prior positive C difficile testing in last 8 weeks, without other identified causes of diarrhea, and with clinical symptoms. Cases had positive confirmatory testing for C difficile. Controls had negative testing for C difficile and were matched to cases 1:1 by age and year of specimen collection.
Results:
The overall incidence rate of community-acquired CDI in this cohort was 13.7 per 100 000 children per year. There was a substantial increase in community-acquired CDI from 9.6 per 100 000 children per year in 2012 to a peak of 16.9 per 100 000 children per year in 2015 (Cochran-Armitage test for trend P = .002). The risk factors for community-acquired CDI included non-Hispanic ethnicity; amoxicillin-clavulanate, cephalosporin, and clindamycin use within the previous 12 weeks; a previous positive C difficile test within 6 months; and increased health care visits in the last year.
Conclusions:
As rates of community-acquired CDI are increasing, enhanced antibiotic stewardship and recognition of health care disparities may ease the burden of community-acquired CDI.
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