Antibiotics, PPIs increase risk for CDI in hospitalized children

Prior antibiotic exposure and protein pump inhibitor use were both risk factors for the development of Clostridioides difficile infection, or CDI, in pediatric inpatients, according to results of a meta-analysis published in Infection Control & Hospital Epidemiology.

Perspective from Kristina Bryant, MD

Researchers noted that in adult patients, CDI has been associated with several risk factors, including advanced age, antibiotic exposure and proton pump inhibitor (PPI) use, among others.

“In pediatric patients, hospital-acquired infections due to C. difficile have increased over the last 20 years. However, few studies have looked at risk factors for these infections in children,” Charles Foster, MD, a pediatric infectious diseases specialist at Cleveland Clinic Children’s, said in a press release.

Foster and colleagues conducted a literature search of Medline, Web of Science, Scopus and Embase databases using search terms related to CDI and pediatrics dating back to 1975. They screened 2,033 articles, eventually focusing their meta-analysis on 14 studies that reported on 10,531,699 children, of whom 22,320 developed CDI.

The researchers reported that prior antibiotic exposure (OR = 2.14; 95% CI, 1.31-3.52) and protein pump inhibitor use (OR = 1.33; 95% CI, 1.07-1.64) were associated with an increased risk for CDI in pediatric inpatients. However, subgroup analyses that included only adjusted results suggested that prior antibiotic exposure was not a significant risk factor for CDI.

Hospitalized children who had previously received antibiotics or who used a protein pump inhibitor were more likely to develop Clostridioides difficile infection.

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The researchers also reported that H2 receptor antagonist use and female gender were not significant risk factors for CDI.

“Physicians should remain vigilant and continue judicious use of antibiotics and PPIs in hospitalized patients to minimize the risk of C. difficile infections,” researcher Abhishek Deshpande, MD, PhD, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine, said in the release.

The researchers concluded that “higher quality adjusted studies of risk factors in the pediatric population with better defined study parameters and definitions for risk factors are needed to validate these results and to further explore other potential risk factors, including the risk associated with specific antibiotic classes.” – by Bruce Thiel

Disclosures: Deshpande reported receiving research support from 3M, Clorox and STERIS unrelated to the study. All other authors reported no relevant financial disclosures.

Perspective

Kristina Bryant, MD

CDIs are increasing in hospitalized children, and identifying modifiable risk factors is crucial to prevention efforts. This meta-analysis largely confirms what we thought we knew: prior antibiotic and/or proton pump inhibitor use increase the risk of CDI in hospitalized children. It also highlights where data are lacking, and that additional studies are needed.

Pediatric providers should be judicious in prescribing antibiotics and PPI to children, advising patients and parents about the risks of these drugs.

Kristina Bryant, MD

Member, Society for Healthcare Epidemiology of America board of trustees

Professor of pediatrics, University of Louisville

Disclosures: Bryant reports that she has received honoraria from MedStudy, research funding from Pfizer for clinical vaccine trials, and clinical funding from Kosair Charities for the University of Louisville department of pediatrics fellowship program in pediatric infectious disease exceeding $25,000.

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Sources/Disclosures

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Source:

Anjewierden S, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2109.23.