Antibiotic use, transplants and tubes increased C. difficile risk

Sandora TJ. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e31820bfb29.

Children who had recently received fluoroquinolones or nonquinolone antibiotics, solid organ transplants or had a gastrostomy or jejunostomy tube were at an elevated risk of having Clostridium difficile infection, according to a study published online.

Thomas J. Sandora, MD, MPH, and colleagues from Children’s Hospital Boston conducted a nested case-control study in 2008 that included 95 pediatric patients who were positive for C. difficile and 238 controls. Of the 1,891 tests performed between January and August 2008, 263 children tested positive for C. difficile toxin A/B. The study appeared online in The Pediatric Infectious Disease Journal and is slated to appear in the July print edition.

According to the researchers’ multivariate analyses, predictors of having a positive C. difficile test included a recent solid organ transplant, lack of prior hospitalization, having a gastrostomy or jejunostomy tube, and recent receipt of a fluoroquinolone or nonquinolone antibiotic.

However, children who received C. difficile-active antibiotics within 24 hours before testing had lower odds of testing positive for infection.

The researchers said despite recommendations that restrict routine testing of children aged younger than 1 year for C. difficile, the testing occurred frequently in their study population. Thus, they concluded, “Further education is needed to minimize unnecessary testing and treatment among infants who may be colonized.” The researchers added that diagnostic testing has less utility in patients who are being treated with these antibiotics.

“The take-home message is that pediatricians should consider C. difficile infection in children with these particular risk factors who develop a diarrheal illness,” Sandora told Infectious Diseases in Children.

Disclosure: Dr. Sandora reports no relevant financial disclosures.

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