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Community-associated CDI common in children
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A significant proportion of Clostridium difficile infection among children is community-associated and differences are noted between community-associated and hospital-associated infections, according to recent study findings published in The Pediatric Infectious Disease Journal.
Jonathan D. Crews, MD, department of pediatrics at Baylor College of Medicine, and colleagues evaluated 109 patients (median age, 7 years) with a positive C. difficile test and diarrhea (3 or more unformed stools per day) to determine differences between community-associated (CA) and hospital-associated (HA) CDI and to identify risk factors for severe disease. No exposure to antibiotics or gastric acid suppressants in the 30 days preceding CDI was found in 9.2% of the cases.
Jonathan D. Crews
Almost 38% of patients with CDI had fever. Diarrhea occurred for a median of 5 days and the median maximum of daily stools passed at the peak of illness was 5 per day.
Nearly 46% of patients experienced abdominal pain, 28.4% experienced vomiting, and bloody stools were present in 24.8% of patients, according to the study data.
Overall, 72.5% of patients had testing for additional enteropathogens and three had co-infections.
Forty-eight percent of patients with HA-CDI had fever compared with 24.4% of patients with CA-CDI. However, bloody stools were more common among CA-CDI patients (42.2%) compared with HA-CDI patients (10%). The number of unformed stools passed were greater among patients with HA-CDI (7.7 stools per day) compared with CA-CDI (5.6 stools per day). No significant differences were found for duration of diarrhea, presence of abdominal pain, or presence of vomiting among both groups.
Severe CDI criteria was met in 21.1% of patients. CDI-related complications were found among 7.4% of patients.On multivariate analysis, when controlling for age, the presence of a gastrotomy tube and having community-onset, indeterminate disease (last hospitalization between 4-12 weeks of symptom onset) was associated with severe CDI.
“Clinicians should recognize the potential for community-associated CDI in children, particularly among those with underlying chronic medical conditions and recent exposure to medications that alter the intestinal flora,” Crews told Infectious Diseases in Children. “Severe disease was common among CDI at our institution. Clinicians should consider early identification and treatment of CDI among children with assisted feeding and recent hospitalization.”
Jonathan D. Crews, MD, can be reached at crews@bcm.edu.
Disclosure: The study was funded in part by the National Institute of Diabetes and Digestive Kidney Diseases and the National Institutes of Allergy and Infectious Diseases. The researchers report no relevant financial disclosures.
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