Pediatric Clostridioides difficile Incidence Decreased From 2013-2019

The incidence of Clostridioides difficile infection (CDI) decreased among pediatric patients between 2013 and 2019, potentially owing to changes in diagnostic testing patterns, according to study results published in The Journal of Pediatrics.

In this retrospective study, researchers evaluated the incidence, epidemiology, testing patterns, and treatment outcomes of CDI among pediatric patients hospitalized between 2013 and 2019. Patient information used for this study was sourced from the Pediatric Health Information System, a large database comprising inpatient data from 49 US pediatric tertiary care centers.

The final analysis included a total of 23,052 hospital admissions for CDI, representing 17,142 pediatric patients. Of the patients, the median age was 7 (IQR, 2-13) years, 46.1% were female, 64.6% were White, and the median length of hospitalization was 7 (IQR, 3-18) days. The majority (84%) of CDI admissions were among patients with chronic conditions, including gastrointestinal conditions (41%), malignancy (36%), and immunodeficiency conditions (24%).

The researchers used Poisson generalized linear models to calculate the annual incidence of CDI admissions per 10,000 patient-days during the study period, with adjustments for patient sex, race/ethnicity, and intensive care unit admission. Results showed annual CDI incidence decreased from 7.09 cases (95% CI, 6.15-8.18) in 2013 to 4.89 cases (95% CI, 4.03-5.93) in 2019 (P <.001). Decreases in annual CDI incidences also were observed during this period after stratification of patients into groups on the basis of age (0-1; 2-5; 6-17 years; all P <.001).

In regard to the number of C difficile-specific tests performed per 10,000 patient days, significant decreases were observed between 2013 and 2019 (52.67 tests, 95% CI, 44.67-62.11 and 33.7 tests; 95% CI, 29.48-38.52, respectively; P <.001). Using Spearman correlation to compare changes in C difficile testing rates with annual CDI incidence, rates were significantly correlated in patients aged 0 to 1 years (P <.001) but not among those aged 2 to 5 (P =.052) or 6 to 17 (P =.094) years.

Severe patient outcomes were uncommon during the study period, including colectomy (n=74), toxic megacolon (n=29), and gastrointestinal perforation (n=91). All-cause in-hospital mortality outcomes were noted in 429 (1.9%) patients, but the researchers were unable to confirm CDI-related causality.

Limitations of the study include the potential inclusion of CDI admissions outside of established clinical definitions, as well as the use of billing and procedure codes and the retrospective study design.

“Although rare, severe CDI complications do occur in pediatric patients, and prospective studies will be important to risk-stratify underlying conditions and to test preventive measures for high-risk groups,” the researchers conclude.