Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019

Authors

Price T Edwards
Cary W Thurm
Matthew Hall
Jordan D Busing
Stacy A Kahn
Richard Kellermayer
Larry K Kociolek
Maria M Oliva-Hemker
Julia S Sammons
Madison Weatherly
Kathryn M Edwards
Maribeth R Nicholson

Publication Date

1-1-2023

Journal

The Journal of Pediatrics

DOI

10.1016/j.jpeds.2022.08.030

PMID

36027981

PMCID

PMC9771922

PubMedCentral® Posted Date

1-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Child, Infant, Newborn, Infant, Child, Preschool, Adolescent, Clostridioides difficile, Clostridium Infections, Metronidazole, Anti-Bacterial Agents, Incidence, Neoplasms, C.difficile, pathogen panel, children, incidence

Abstract

OBJECTIVES: To compare the incidence, epidemiology, testing patterns, treatment, and outcomes of Clostridioides difficile infection (CDI) among hospitalized pediatric patients from 2013 to 2019.

STUDY DESIGN: The Pediatric Health Information System database was queried for patient admissions (age 0-17 years) with International Classification of Diseases, 9th and 10th edition, codes for diagnoses of CDI with a billing code for a CDI-related antibiotic treatment.

RESULTS: We identified 17 142 pediatric patients, representing 23 052 admissions, with CDI. The adjusted annual CDI incidence decreased over the study period from 7.09 cases per 10 000 patient-days (95% CI, 6.15-8.18) in 2013 to 4.89 cases per 10 000 patient-days (95% CI, 4.03-5.93) in 2019 (P < .001). C difficile-specific testing also decreased during the study period (P < .001). Chronic gastrointestinal conditions (36%) and malignancy (32%) were the most common comorbidities in CDI encounters. Oral metronidazole use decreased during the study period (P < .01) and oral vancomycin use increased (P < .001).

CONCLUSIONS: Our study demonstrates a decrease in CDI incidence in hospitalized pediatric patients, a notable change from prior studies, although this may have been influenced by altered testing patterns. We found a high incidence of CDI in patients with cancer and gastrointestinal conditions: groups that warrant targeted evaluation of CDI prevention and treatment.