Antibiotic-use, immunocompromised conditions increased risk for C. difficile in children

VANCOUVER — Children recently exposed to antibiotics and immunocompromised conditions are at increased risk for C. difficile infection, according to new findings from a nested, case-controlled study in children aged younger than 18 years.

“There are several known risk factors for C. difficile in adults that include the use of fluoroquinolone, hospitalization and medication use that suppresses stomach acid. Yet, there are limited data on risk factors for C. difficile in children. As far as we are aware, our study is the first to show an increase in infection with fluoroquinolone use in children,” Thomas J. Sandora, MD, MPH, of the division of infectious diseases at Children's Hospital Boston, said during a press conference at the IDSA 48th Annual Meeting.

Sandora and colleagues set out to assess the risk factors for C. difficile infection in children treated at a large quaternary care hospital.

Of the 1,891 tests performed between January through August 2008, 263 children tested positive for C. difficile toxin A/B. Each case was then compared with two unmatched controls with negative test results (n=1,628). Independent predictors of C. difficile were identified via multivariate logistic regression.

Twenty-four percent of children with positive test results had colonization; concurrent infection was identified in 5%. In multivariate analysis, researchers compared 94 children aged 1 year or older who had a documented C. difficile infection with 238 controls. Predictors of C. difficile included:

Solid organ transplant (OR=8.09; 95% CI, 2.10-31.12).
Lack of prior hospitalization (OR=8.43; 95% CI, 4.39-16.2).
G or J tube (OR=3.32; 95% CI, 1.71-6.42).
and receipt of antibiotics in past 4 weeks (for fluoroquinolones: OR=17.04; 95% CI, 5.86-49.54; for non-quinolone antibiotics OR=2.23; 95% CI, 1.18-4.2).

However, children who received C. difficile-active antibiotics within 24 hours before testing had lower odds of testing positive for infection (OR=0.23; 95% CI, 0.09-0.58).

“C. difficile infections are exceedingly important in the hospital environment and are increasingly problematic in terms of antibacterial resistance,” Richard Whitley, MD, President of IDSA, and director of the division of pediatric infectious diseases at the University of Alabama, said during the press conference.

Sandora TJ. #817. Presented at: the IDSA 48th Annual Meeting; Oct. 21-24, 2010; Vancouver, B.C.

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