Incidence Rate and Risk Factors for Recurrent Clostridium difficile Infection in Pediatric At-Risk Groups

Abstract

Background: Recurrence rates and risk factors of Clostridium difficile infection (CDI) are well established in adults, though little is known about the rate of recurrent CDI (rCDI) within the pediatric population. The purpose of this study was to identify rates and risk factors of rCDI in pediatric at-risk groups to guide the optimization of targeted prevention efforts against disease recurrence. Methods: We report on the ongoing retrospective cohort study of pediatric patients at the CHU Sainte-Justine with a laboratory confirmed diagnosis of CDI between April 1, 2012, and March 31, 2017. Incidence rates of rCDI were obtained per 100 cases. Frequencies of rCDI were compared using the Fisher exact test. Univariate and multivariate logistic regression were used to identify risk factors for rCDI. Two-tailed P < .05 was considered significant. All statistical calculations were performed using R version 3.5.2 software. Results: Of 80 patients analyzed with CDI, 16 had rCDI, for a rCDI rate in this population of 20%. Most recurrences were observed in secondarily immunosuppressed patients including, but not limited to, oncology patients undergoing chemotherapy and/or radiotherapy (30.4%) and patients with inflammatory bowel disease (IBD, 29.2%). Patients that were administered vancomycin orally (PO) had recurrent infection less often than patients that administered metronidazole PO or IV (8.3% vs 23.4%, respectively). This trend was observed in all at-risk patient groups. Patients with secondary immunodeficiency had 7.4 times increased odds of recurrence compared to nonimmunodeficient patients (adjusted OR, 7.43,; 95% CI, 1.84–50.4; P = .0126). Conclusions: Initial vancomycin PO therapy seems to be associated with a lower risk of recurrence. Pediatric patients with IBD and with secondary immunodeficiency are at increased risk of rCDI. Given that these populations have an increased underlying risk of diarrhea, it would be worthwhile to determine whether toxin is actually produced (EIA testing) and to prioritize prevention efforts.

Funding: None

Disclosures: None