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Clostridioides difficile Infection in Children: A 5-Year Multicenter Retrospective Study
Danilo Buonsenso1,2,3, Rosalia Graffeo4, Davide Pata1
1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
Insights
Pediatric Clostridioides difficile infection (CDI) is understudied. This study found that children with CDI had more hospital admissions, chronic conditions, and prior antibiotic/proton pump inhibitor use, particularly fluoroquinolones.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Gastroenterology
Background:
- Clostridioides difficile infection (CDI) research predominantly focuses on adults, with limited data on pediatric cases.
- Understanding pediatric CDI epidemiology is crucial for targeted prevention and treatment strategies.
Purpose of the Study:
- To conduct a clinical and epidemiological analysis of pediatric Clostridioides difficile infection.
- To identify risk factors associated with CDI in children.
Main Methods:
- Retrospective study conducted over 5 years (January 2014 - December 2018) in two Italian referral centers.
- Analysis of 359 pediatric patients tested for CDI, comparing 87 positive cases with 272 negative controls.
- Statistical analysis to identify significant differences in demographics, comorbidities, and prior medication use.
Main Results:
- Children with CDI exhibited significantly higher rates of previous-day hospital admissions, hospitalizations, and total admissions compared to controls.
- Chronic comorbidities were more prevalent in the CDI group (66.7% vs. 33.3%).
- Previous use of proton pump inhibitors and antibiotics (specifically fluoroquinolones) was strongly associated with CDI (p < 0.001).
Conclusions:
- Pediatric CDI is associated with increased healthcare utilization and specific risk factors including comorbidities and prior medication exposure.
- Fluoroquinolone use and proton pump inhibitor use are significant risk factors for CDI in children.
- Further prospective studies are recommended to refine risk factor identification and develop preventive measures for pediatric CDI.
Abstract:
While there are numerous studies regarding Clostridioides difficile infection (CDI) in adults, literature on the pediatric population is scarce. Therefore, we performed a 5-year retrospective study between January 2014 and December 2018 in two referral centers in Rome, Italy. There were 359 patients tested for CDI who were enrolled: 87 resulted in positive and 272 in negative. CDI children had a higher number of previous-day hospital admissions (p = 0.024), hospitalizations (p = 0.001), and total hospital admissions (p = 0.008). Chronic comorbidities were more frequent in the CDI group (66.7% vs. 33.3%). Previous use of proton pump inhibitors and antibiotics was associated with CDI (p < 0.001). Among the antibiotics, only fluoroquinolones were significantly associated with CDI. Also, CDI children were more frequently exposed to antibiotics during the episode of hospitalization when children were tested. Our study provides an updated clinical and epidemiological analysis of children with CDI compared with a control group of children who tested negative. Further prospective studies could better define risk factors and preventive methods.
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