Loading...
Clostridium difficile infections (CDIs) are a well-known cause of diarrhea in children older than 1 year. Although much is known about the increasing frequency and severity of CDIs in adults, less in known about these trends in the pediatric population. Researchers tracked the number and severity of CDIs in U.S. children, using a large nationwide inpatient database (the Triennial Healthcare Cost and Utilization Project Kids' Inpatient Databases) for 1997, 2000, 2003, and 2006.
Between 1997 and 2006, the number of CDI cases in children older than 1 year more than doubled, from 3565 to 7779, while severity indicators (length of stay, mortality, and colectomy rates) for CDI did not increase. All severity indicators were higher in children with CDI compared with other hospitalized children. Patients with CDI were also younger (9.5 vs. 11.9 years) and more likely to be white (64% vs. 54%) and to have private insurance (56% vs. 49%). Multiple comorbidities, including inflammatory bowel disease, any immunodeficiency, and antimicrobial therapy, increased risk for CDI.
Nylund CM et al. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med 2011 Jan 3; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archpediatrics.2010.282)
Comment
This study represents more than 85% of pediatric inpatient stays in the U.S., indicating that the marked increase of CDI is widespread and not confined to tertiary care centers. Although data on antibiotic use prior to hospitalization were not available, overprescribing antibiotics leads to resistance and thus might account for the higher rates of infection among whites and those with private insurance. The data serve as a reminder about the judicious use of antibiotics and the importance of proper hand hygiene. Finally, although this study did not show an increase in disease severity, I am seeing more relapses and refractory CDI after children leave the hospital. Children who are still symptomatic should be retested and, if positive, treated again. Failure to respond to another course of therapy should prompt referral to an infectious diseases specialist or gastroenterologist.