Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan:252:111-116.e1.
doi: 10.1016/j.jpeds.2022.08.030. Epub 2022 Aug 24.

Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019

Price T Edwards  1 , Cary W Thurm  2 , Matthew Hall  2 , Jordan D Busing  3 , Stacy A Kahn  4 , Richard Kellermayer  1 , Larry K Kociolek  5 , Maria M Oliva-Hemker  6 , Julia S Sammons  7 , Madison Weatherly  4 , Kathryn M Edwards  8 , Maribeth R Nicholson  9
Affiliations

Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019

Price T Edwards et al. J Pediatr. 2023 Jan.

Abstract

Objectives: To compare the incidence, epidemiology, testing patterns, treatment, and outcomes of Clostridioides difficile infection (CDI) among hospitalized pediatric patients from 2013 to 2019.

Study design: The Pediatric Health Information System database was queried for patient admissions (age 0-17 years) with International Classification of Diseases, 9th and 10th edition, codes for diagnoses of CDI with a billing code for a CDI-related antibiotic treatment.

Results: We identified 17 142 pediatric patients, representing 23 052 admissions, with CDI. The adjusted annual CDI incidence decreased over the study period from 7.09 cases per 10 000 patient-days (95% CI, 6.15-8.18) in 2013 to 4.89 cases per 10 000 patient-days (95% CI, 4.03-5.93) in 2019 (P < .001). C difficile-specific testing also decreased during the study period (P < .001). Chronic gastrointestinal conditions (36%) and malignancy (32%) were the most common comorbidities in CDI encounters. Oral metronidazole use decreased during the study period (P < .01) and oral vancomycin use increased (P < .001).

Conclusions: Our study demonstrates a decrease in CDI incidence in hospitalized pediatric patients, a notable change from prior studies, although this may have been influenced by altered testing patterns. We found a high incidence of CDI in patients with cancer and gastrointestinal conditions: groups that warrant targeted evaluation of CDI prevention and treatment.

Keywords: C difficile; children; incidence; pathogen panel.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest disclosures: The authors declare no conflicts of interest.

Figures

Figure 1)
Figure 1)
A. The yearly incidence of hospital admissions with a diagnosis of CDI from 2013–2019 in 42 pediatric hospitals (per 10,000 patient-days) were calculated using Poisson generalized linear models, adjusted for patient characteristics and co-morbid conditions. B. Frequency of C. difficile-specific testing per 10,000 patient days.
Figure 2)
Figure 2)
Panel based testing rates per 10,000 patient days in hospitalized children.
Figure 3)
Figure 3)
Antibiotic use for the treatment of C. difficile infection in hospitalized children from 2013 to 2019.
See this image and copyright information in PMC

References

    1. Sammons JS, Localio R, Xiao R, Coffin SE, Zaoutis T. Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children. Clin Infect Dis 2013;57(1):1–8. - PMC - PubMed
    1. Wendt JM, Cohen JA, Mu Y, et al. Clostridium difficile infection among children across diverse US geographic locations. Pediatrics 2014;133(4):651–658. - PMC - PubMed
    1. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2018. - PMC - PubMed
    1. Kim J, Smathers SA, Prasad P, Leckerman KH, Coffin S, Zaoutis T. Epidemiological features of Clostridium difficile-associated disease among inpatients at children’s hospitals in the United States, 2001–2006. Pediatrics 2008;122(6):1266–1270. - PubMed
    1. Khanna S, Baddour LM, Huskins WC, et al. The epidemiology of Clostridium difficile infection in children: a population-based study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2013;56(10):1401–1406. - PMC - PubMed

Publication types