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Clostridioides difficile Infection Risk in Children Prescribed Antibiotics for Tonsillectomy

Erin M Gawel1, Gaayathri Varavenkataraman2, Luke Reardon3

  • 1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|October 31, 2025
PubMed

Insights

Antibiotic use after pediatric tonsillectomy significantly increases the risk of Clostridioides difficile infection (CDI). This study found a fourfold higher risk in children receiving antibiotics, highlighting the need for careful antibiotic stewardship in surgical care.

Area of Science:

  • Infectious Diseases
  • Pediatric Surgery
  • Clinical Microbiology

Background:

  • Antibiotic prophylaxis is not routinely recommended for pediatric tonsillectomy.
  • Clostridioides difficile infection (CDI) is a significant healthcare-associated infection.
  • Understanding risk factors for CDI in pediatric surgical patients is crucial.

Purpose of the Study:

  • To determine if antibiotic administration following pediatric tonsillectomy is associated with an increased incidence of Clostridioides difficile infection (CDI).

Main Methods:

  • A retrospective cohort study was conducted using the US TriNetX network.
  • Pediatric patients (<18 years) undergoing tonsillectomy between 2006-2024 were identified.
  • Propensity score matching was used to compare cohorts with and without antibiotic exposure within 7 days of surgery, assessing CDI occurrence within 90 days.

Main Results:

  • Antibiotics were prescribed to 16.5% of pediatric tonsillectomy patients.
  • The prevalence of CDI was significantly higher in the antibiotic group (0.07%) versus the non-antibiotic group (0.02%).
  • Antibiotic exposure was associated with a fourfold increased risk of CDI (RR=4.2, 95% CI: 2.1-8.4).

Conclusions:

  • A substantial percentage of children receive antibiotics post-tonsillectomy, contrary to guidelines.
  • Post-tonsillectomy antibiotic use is linked to a significantly elevated risk of developing Clostridioides difficile infection.
  • These findings underscore the critical importance of antibiotic stewardship to minimize CDI risk in pediatric surgical settings.
Abstract

Keywords:
Clostridioides difficileantibiotic usehealthcare‐associated infectiontonsillectomy

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