Community-Acquired Clostridium difficile Risk Factors in Children

Clostridium difficile
Clostridium difficile
Outpatient antibiotic use may reduce community-acquired C diff infections in pediatric at-risk populations
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SAN DIEGO — In young children in the United States, underlying medical conditions, a neonatal intensive care unit (NICU) stay after birth, and recent antibiotic exposure have been associated with community-acquired Clostridium difficile infection, according to a study presented at IDWeek 2017.

In this case-control study, children between age 12 and 60 months with positive C difficile stool specimens were matched with controls who had no history of C difficile infection by geographical site and age group. A total of 138 children were enrolled in the study (43.5% female; 69.6% 12 to 23 months old). To determine risk factors associated with C difficile infection, univariate analysis with exact conditional logistic regression was performed.

Compared with patients with no history of C difficile infection, patients with C difficile infections had significantly higher rates of underlying chronic medical conditions (33.3% vs 11.9%; P =.02), NICU stays following birth (26.9% vs 13.2%; P =.04), and recent antibiotic exposure (53.6% vs 20.6%; P <.0001).

The researchers reported a nonsignificant trend toward increased higher-risk outpatient healthcare exposures (34.9% vs 19.1%; P =.06) and a household member with diarrhea (36.2% vs 20.6%; P =.05) in children with C difficile compared with controls.

No significant difference was noted between the 2 groups with the presence of a feeding tube (2.9% vs 0% for cases vs controls; P =.50) or recent exposure to gastric acid suppressants (6.1% vs 2.9%; P =.63).

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“Young children with underlying disease, NICU stay, or recent antibiotic use might be at higher risk for [community-acquired C difficile infection],” the researchers concluded. “Improving outpatient antibiotic use, particularly among children with comorbidities, might reduce [community-acquired C difficile infection] in this population.”

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Weng M, Adkins SH, Farley M, et al. Risk factors for community-associated Clostridium difficile infection in children. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Poster 2286.