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Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and
Price T Edwards1, Cary W Thurm2, Matthew Hall2
1Section of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
Insights
The incidence of Clostridioides difficile infection (CDI) in hospitalized children decreased from 2013 to 2019. Testing patterns also changed, with increased oral vancomycin use for pediatric CDI.
Area of Science:
- Pediatric Infectious Diseases
- Healthcare Epidemiology
- Antimicrobial Stewardship
Background:
- Clostridioides difficile infection (CDI) is a significant cause of hospital-acquired infections in children.
- Understanding trends in pediatric CDI is crucial for effective prevention and treatment strategies.
Purpose of the Study:
- To analyze the incidence, epidemiology, testing patterns, treatment, and outcomes of CDI in hospitalized pediatric patients between 2013 and 2019.
- To identify trends in CDI diagnosis and management within this demographic.
Main Methods:
- Utilized the Pediatric Health Information System database for patient admissions (ages 0-17).
- Included International Classification of Diseases codes for CDI diagnoses and CDI-related antibiotic treatments.
- Analyzed data from 2013 to 2019 to assess changes in CDI incidence and management.
Main Results:
- Identified 17,142 pediatric patients with CDI across 23,052 admissions.
- Observed a significant decrease in adjusted annual CDI incidence from 7.09 to 4.89 cases per 10,000 patient-days (P < .001).
- Noted a decrease in CDI-specific testing and a shift in antibiotic use from metronidazole to vancomycin.
Conclusions:
- Pediatric CDI incidence has declined, contrasting with some previous studies, possibly influenced by testing pattern changes.
- Patients with chronic gastrointestinal conditions and malignancy represent high-risk groups for CDI.
- Targeted prevention and treatment strategies are recommended for pediatric cancer and gastrointestinal patients.
Objectives:
To compare the incidence, epidemiology, testing patterns, treatment, and outcomes of Clostridioides difficile infection (CDI) among hospitalized pediatric patients from 2013 to 2019.
Study Design:
The Pediatric Health Information System database was queried for patient admissions (age 0-17 years) with International Classification of Diseases, 9th and 10th edition, codes for diagnoses of CDI with a billing code for a CDI-related antibiotic treatment.
Results:
We identified 17 142 pediatric patients, representing 23 052 admissions, with CDI. The adjusted annual CDI incidence decreased over the study period from 7.09 cases per 10 000 patient-days (95% CI, 6.15-8.18) in 2013 to 4.89 cases per 10 000 patient-days (95% CI, 4.03-5.93) in 2019 (P < .001). C difficile-specific testing also decreased during the study period (P < .001). Chronic gastrointestinal conditions (36%) and malignancy (32%) were the most common comorbidities in CDI encounters. Oral metronidazole use decreased during the study period (P < .01) and oral vancomycin use increased (P < .001).
Conclusions:
Our study demonstrates a decrease in CDI incidence in hospitalized pediatric patients, a notable change from prior studies, although this may have been influenced by altered testing patterns. We found a high incidence of CDI in patients with cancer and gastrointestinal conditions: groups that warrant targeted evaluation of CDI prevention and treatment.
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