Hostname: page-component-745bb68f8f-v2bm5 Total loading time: 0 Render date: 2025-01-08T11:45:30.688Z Has data issue: false hasContentIssue false
  • English
  • Français

Changing Epidemiology of Clostridium difficile-Associated Disease in Children

Published online by Cambridge University Press:  02 January 2015

Lacey Benson ,
Xiaoyan Song ,
Joseph Campos  and
Nalini Singh
Lacey Benson
Affiliation:
Case Western School of Medicine, Cleveland Ohio
Xiaoyan Song
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Children's National Medical Center, Washington DC
Joseph Campos
Affiliation:
Department of Pediatrics, Washington DC Department of Pathology, Washington DC Department of Microbiology–Tropical Medicine, the Division of Laboratory Medicine, Washington DC Division of Infectious Diseases, George Washington University School of Medicine, Washington DC
Nalini Singh*
Affiliation:
Department of Pediatrics, Washington DC Children's National Medical Center, Washington DC Departments of Epidemiology and International Health, George Washington University School of Public Health, Washington DC
*
Epidemiology and International Health, theGeorge Washington University, Schools of Medicine and Public Health, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine temporal trends in the incidence rate for Clostridium difficile-associated disease (CDAD) in a pediatric patient population.

Methods.

We performed an observational, retrospective cohort study that included children who visited or were admitted to Children's National Medical Center during the period from July 2001 through June 2006. The CDAD incidence rates were determined and examined for changes over time using the Poisson regression method.

Results.

A total of 513 patients whose stool specimens tested positive for C. difficile toxin were identified. Of these patients, 61% were children aged 2 years or older. The proportion of patients with CDAD in this age group has steadily increased from 46% in 2001 to 64% in 2006. Largely as a result of an increasing number of cases of community-associated CDAD, the incidence of CDAD increased significantly in the outpatient setting, particularly in the emergency department (1.18 cases per 1,000 visits in 2001 vs 2.47 cases per 1,000 visits in 2006; P = .02). The incidence among inpatients decreased during the study period (1.024 cases per 1,000 patient-days in 2001 vs 0.680 cases per 1,000 patient-days in 2006; P = .004). In the neonatal intensive care unit, C. difficile toxin was detected in stool specimens collected from 22 patients aged from 15 days to 6 months.

Conclusion.

This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children—a population that has not been considered to be at high risk for this disease in the past—are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1233 - 1235
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
2.Pepin, J, Alary, ME, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591–1597.CrossRefGoogle ScholarPubMed
3.Pepin, J, Valiquette, L, Alary, ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.CrossRefGoogle Scholar
4.Al-Jumaili, IJ, Shibley, M, Lishman, AH, Record, CO. Incidence and origin of Clostridium difficile in neonates. J Clin Microbiol 1984;19:77–78.CrossRefGoogle ScholarPubMed
5.Larson, HE, Barclay, FE, Honour, P, Hill, ID. Epidemiology of Clostridium difficile in infants. J Infect Dis 1982;146:727–733.CrossRefGoogle ScholarPubMed
6.Han, VK, Sayed, H, Chance, GW, et al. An outbreak of Clostridium difficile necrotizing enterocolitis: a case for oral vancomycin therapy? Pediatrics 1983;71:935–941.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. Severe Clostridium difficile associated disease in populations previously at low risk—four states, 2005. MMWR Morb Mortal Wkly Rep 2005;54:1201–1205.Google Scholar
8.Klein, EJ, Boster, DR, Stapp, JR, et al. Diarrhea etiology in a children's hospital emergency department: a prospective cohort study. Clin Infect Dis 2006;43:807–813.Google Scholar
9.Johnson, S, Kent, SA, O'Leary, KJ, et al. Fatal pseudomembranous colitis associated with a variant Clostridium difficile not detected by toxin A immunoassay. Ann Intern Med 2001;135:434–438.CrossRefGoogle Scholar
10.Loo, VG, Miller, MA, Oughton, M, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
11.Poutanen, S, Simor, AE. Clostridium difficile associated diarrhea in adults. CMAJ 2004;171:51–58.CrossRefGoogle ScholarPubMed