Impact of Antecedent Antibiotic Usage on Community-associated Clostridioides difficile Infection in Pediatrics

Area of Science:

• Pediatric infectious diseases
• Antimicrobial stewardship
• Microbiome research

Background:

• Antibiotics are crucial for treating childhood infections but can disrupt the gut microbiome.
• Community-associated Clostridioides difficile infections (CA-CDI) are a growing concern in pediatric populations.
• Understanding antibiotic-specific risks for CA-CDI is essential for optimizing treatment guidelines.

Purpose of the Study:

• To investigate the association between specific antibiotic classes and the incidence of CA-CDI in children.
• To compare the risk of CA-CDI following exposure to commonly prescribed pediatric antibiotics.
• To identify antibiotics that may confer a higher risk for CA-CDI.

Main Methods:

• Retrospective analysis of a pediatric cohort with filled antibiotic prescriptions.
• Inclusion criteria: children with prescriptions between January 1, 2012, and December 31, 2016.
• Statistical comparison of CA-CDI incidence rates across different antibiotic classes, with amoxicillin as a reference.

Main Results:

• Children exposed to antibiotics had an increased incidence of CA-CDI within 12 weeks.
• Compared to amoxicillin, higher CA-CDI incident rates were observed following clindamycin, cephalosporins, and amoxicillin-clavulanate.
• Amoxicillin was associated with the lowest incidence of CA-CDI among the studied antibiotics.

Conclusions:

• Antibiotic selection in children significantly impacts the risk of developing CA-CDI.
• Clindamycin, cephalosporins, and amoxicillin-clavulanate represent higher-risk antibiotic classes for CA-CDI in pediatric patients.
• This study supports the need for judicious antibiotic prescribing and consideration of CA-CDI risk when choosing treatments for children.