Risk Factors for Community-associated Clostridium difficile-associated Diarrhea in Children. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Crews, Jonathan D.; Anderson, Lauren R.; Waller, D. Kim; Swartz, Michael D.; DuPont, Hebert L.; Starke, Jeffrey R.
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 9(2015)
• Publication Date: 2015-09
• Subjects: Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000767
• Languages: English
• ISSNs: 0891-3668

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p> <italic>Clostridium difficile</italic>-associated diarrhea (CDAD) is increasingly diagnosed in children in community settings. This study aims to assess recent antibiotic use and other risk factors in children with community-associated (CA-) CDAD compared with children with other diarrheal illnesses in a tertiary care setting.</p> </sec> <sec> <title>Methods:</title> <p>Children with CA-CDAD evaluated at Texas Children's Hospital (Houston, TX) from January 1, 2012 to June 30, 2013 were identified. Two control subjects with community-associated diarrhea who tested negative for <italic>C. difficile</italic> were matched to case subjects. Data on demographics, medication exposure and outpatient healthcare encounters were collected from medical records. Multivariate logistic regression was performed to identify predictors of pediatric CA-CDAD.</p> </sec> <sec> <title>Results:</title> <p>Of 69 CA-CDAD cases, most (62.3%) had an underlying chronic medical condition and 40.6% had antibiotic exposure within 30 days of illness. However, no traditional risk factor for CDAD was identified in 23.2% and 15.9% of CA-CDAD cases within 30 and 90 days of illness onset, respectively. Outpatient healthcare encounters within 30 days were more common among CA-CDAD cases than control subjects (66.7% vs. 48.6%; <italic>P</italic> = 0.01). In the final multivariate model, CA-CDAD was associated with cephalosporin use within 30 days [odds ratio: 3.32; 95% confidence interval: 1.10–10.01] and the presence of a gastrointestinal feeding device (odds ratio: 2.59; 95% confidence interval: 1.07–6.30).</p> </sec> <sec> <title>Conclusions:</title> <p>Recent use of cephalosporins and the presence of gastrointestinal feeding devices are important risk factors for community- associated CDAD in children. Reduction in the use of outpatient antibiotics may decrease the burden of CA-CDAD in children.</p> </sec> </abstract>