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Community-associated CDI recurrent disease
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Symptomatic recurrence of Clostridium difficile infection occurred in more than 10% of hospitalized children, according to recent study results.
Sarah Tschudin-Sutter, MD, MSc, of Johns Hopkins University School of Medicine and colleagues examined all patients hospitalized for CDI at Johns Hopkins Children’s Hospital from July 2003 to July 2012 to determine recurrence rate. Children met inclusion criteria if appropriate CDI clinical symptoms were identified including diarrhea as three or more loose stools per day exclusion of other causes of diarrhea clinical confirmation of the diagnosis.
During a 9-year study period, 12% of children had recurrent CDI, defined as an episode of CDI that occurred 8 weeks or less after the onset of a previous episode, provided that CDI symptoms from the earlier episode completely resolved with or without therapy.Researchers found that patients with recurrence were more likely to be younger and first CDI episode was most likely community-associated.
Additional antibiotics were often prescribed for non-CDI indications during treatment of initial CDI episodes in patients with recurrence (P=.06). Trimethoprimsulfamethoxazole the most common antibiotic continued during CDI treatment (42.9%) followed by penicillin (27.5%), cephalosporin (26.4%), aminoglycosides (22%), macrolides (16.5%), carbapenems (11%), quinolones (7.7%) and clindamycin (2.2%). Recurrence was not associated with a single class of antibiotics, antacids or antiretrovirals that were administered concomitantly.
Community-associated CDI was associated with recurrent disease (OR=5.07; 95% CI, 1.71-15.07) as well as receipt of additional antibiotics (OR=3.85; 95% CI, 1.28-11.58).
“In conclusion, recurrence rate was 12% during the 9-year study period in pediatric inpatients,” the researchers wrote in The Pediatric Infectious Disease Journal. “Community-associated disease and concomitant use of systemic antibiotics were independent predictors for recurrence. Antibiotics administered for reasons other than treatment of CDI should be discontinued whenever possible.”
Disclosure: Tschudin-Sutter reports financial relationships with the Swiss National Foundation, the Medical Division of the Lichtenstein Foundation of the University of Basel, Switzerland, and the Scientific Society Basel, Switzerland.
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