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. 2014 Apr;133(4):651-8.
doi: 10.1542/peds.2013-3049. Epub 2014 Mar 3.

Clostridium difficile infection among children across diverse US geographic locations

Joyanna M Wendt  1 , Jessica A Cohen, Yi Mu, Ghinwa K Dumyati, John R Dunn, Stacy M Holzbauer, Lisa G Winston, Helen L Johnston, James I Meek, Monica M Farley, Lucy E Wilson, Erin C Phipps, Zintars G Beldavs, Dale N Gerding, L Clifford McDonald, Carolyn V Gould, Fernanda C Lessa
Affiliations

Clostridium difficile infection among children across diverse US geographic locations

Joyanna M Wendt et al. Pediatrics. 2014 Apr.

Abstract

Objective: Little is known about the epidemiology of Clostridium difficile infection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups.

Methods: Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010-2011 were used to identify cases (ie, residents with C difficile-positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years.

Results: Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100,000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks.

Conclusions: Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.

Keywords: Clostridium difficile; antimicrobial stewardship; community-associated; pediatric.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Gerding is a board member of Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist, all of which perform research on potential Clostridium difficile products; and he is a consultant for and has patents licensed to Viropharma, which makes vancomycin used to treat C difficile infection; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Pediatric CDI crude incidence per 100 000 children by age, 2010–2011 (N = 944).
FIGURE 2
FIGURE 2
Proportion of pediatric CDI cases in each epidemiologic class by age group.
See this image and copyright information in PMC

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