This article is more than 5 years old. Information may no longer be current.
Mortality risk greater in children with severe C. difficile, chronic conditions
Click Here to Manage Email Alerts
Certain chronic comorbidities and more severe infection were associated with a higher mortality risk among children with Clostridium difficile infection, according to recent data.
In the retrospective, multicenter cohort study, researchers evaluated 7,318 cases of pediatric C. difficile infection identified from the Pediatric Health Information System (PHIS) database. All patients were aged 1 to 18 years and discharged from 41 PHIS hospitals from January 2006 through August 2011. Demographic and clinical data, including race, existence and type of comorbid condition, and in-hospital medications (antimicrobial agents, proton pump inhibitors, H2 blockers, and total parenteral nutrition), were recorded. The primary outcome was all-cause in-hospital mortality during an index hospital admission within 30 days of a C. difficile test.
The overall mortality rate in the cohort was 1.5%, with a median of 12 days between C. difficile testing and death.
Independent risk factors for in-hospital mortality included markers of severe illness, number of antibiotic classes administered within 30 days before C. difficile test, use of proton pump inhibitors or H2 blockers within 30 days, use of parenteral nutrition within 30 days, hospital length of stay before C. difficile, and community-onset C. difficile infection. Risk factors identified through multivariate analysis included the existence of at least one indicator of severe illness (adjusted OR = 3.88; 95% CI, 2.44-6.19), underlying malignancy (aOR = 3.57; 95% CI, 2.36-5.4), suppressed gastric acid (aOR = 2.7; 95% CI, 1.43-5.08), older age (aOR = 2.29; 95% CI, 1.4-3.77), cardiovascular disease (aOR = 2.06; 95% CI, 1.28-3.3), and hematologic or immunologic conditions (aOR = 1.89; 95% CI, 1.05-3.39).
These findings may be valuable in guiding future treatment of at-risk cohorts of C. difficile patients, the researchers said.
“Identifying subgroups of children with [C. difficile infection] who are at higher risk of poor outcomes is crucial and may inform the design of future studies to determine the optimal treatment of [C. difficile infection] in children,” the researchers wrote. “In addition, these children may benefit from targeted [C. difficile infection] prevention strategies, such as antibiotic stewardship programs.” – by Jen Byrne
Disclosure : Vendetti reports receiving research support from Merck. Please see the full study for a list of all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts