Risk Factors for Asymptomatic C difficile Colonization in Children With Cystic Fibrosis

Risk factors for asymptomatic C difficile colonization in children with cystic fibrosis included a higher BMI and recent exposure to certain antibiotic drug classes.

High BMI and recent exposure to certain antibiotic drug classes are significant risk factors for asymptomatic Clostridioides difficile colonization in children with cystic fibrosis (CF), according to study results published in the Journal of Cystic Fibrosis.

Between November 2017 and December 2019, researchers used univariate and multivariate logistic regression models to analyze rates and risk factors for asymptomatic C difficile colonization among children with CF. The models were adjusted for demographic and clinical risk factors for C difficile infection (CDI), including BMI, antibiotic use, sex, age, prior CDI diagnosis, comorbidities, and hospitalization within the past 90 days. Stool samples were collected from the patients and subsequently evaluated for the development of CDI at days 30, 60, and 90.

A total of 108 unique patients submitted stool samples for this analysis. The mean (SD) patient age was 9.2 (4.2) years, 49.1% were women or girls, 31.5% were hospitalized within the past 90 days, and the mean (SD) BMI was 18.7 (4.1) kg/m2. The most common comorbidities were pancreatic insufficiency (88.0%) and gastroesophageal reflux disease (50.9%). Antibiotic exposure within the past 30 days was reported by 54 patients, of whom 23.1%, 14.8%, and 13.0% were exposed to cephalosporins, antianaerobics, and vancomycin, respectively.

Further study on potential sources of spread and the genetic relationship between strains from patients with CF colonized with C. difficile strains associated with hospital-acquired disease is warranted.

Of the 108 stool samples, 35 (32.4%) were positive for CDI via nucleic acid amplification testing. In the univariate model, the researchers found an association between higher BMI and an increased risk for C difficile colonization (odds ration [OR], 4.74; 95% CI, 1.82–12.9; P =.002). Recent exposure to cephalosporins (OR, 4.74; 95% CI, 1.82–12.9; P =.002), fluoroquinolones (OR, 7.34; 95% CI, 1.59-52.2; P =.018), and vancomycin (OR, 4.71; 95% CI, 1.49–16.6; P =.01) also were significantly associated with colonization in this model.

Data from the multivariate logistic regression model showed only a higher BMI remained significantly associated with C difficile colonization (OR, 1.34; 95% CI, 1.05–1.71; P =.017). In previous studies performed among adult patients, higher BMI was also a risk factor for C difficile colonization.

Of note, no patient developed CDI colonization during the 90-day follow-up period.

Study limitations include the inability to identify and assess the effect of different CDI strains.

“Further study on potential sources of spread and the genetic relationship between strains from patients with CF colonized with C difficile strains associated with hospital-acquired disease is warranted,” the researchers concluded.

References:

Reasoner SA, Fazili IF, Bernard R, et al. Prevalence, risk factors, and sequelae of asymptomatic Clostridioides difficile colonization in children with cystic fibrosis. J Cyst Fibros. Published online December 28, 2022. doi:10.106/j.jcf.2022.12.014