Community-associated Clostridium difficile infection in children: Characteristics and risk factors

Jonathan D Crews, The University of Texas School of Public Health


Objective: Children increasingly are diagnosed with Clostridium difficile infection (CDI) in community settings. The aim of this study was to characterize and identify the risk factors for community-associated (CA-) CDI in children. Methods: Children with CA-CDI evaluated at Texas Children's Hospital from January 1, 2012 through June 30, 2013 were identified. Two control subjects, frequency matched by age group, were randomly selected among children with community-associated (symptom onset > 12 weeks after last hospitalization) diarrhea who tested negative for C. difficile. Data on demographics, medication use, and outpatient healthcare encounters were collected from medical records. Multivariate logistic regression was performed to identify predictors of pediatric CA-CDI. Results: A total of 69 CA-CDI cases were identified and compared with 138 control subjects. The majority (62.3%) of pediatric CA-CDI cases had an underlying chronic medical condition. CA-CDI cases commonly had exposure to antibiotics (40.6%) and gastric acid suppressants (21.7%) within 30 days of illness. On univariate analysis, CA-CDI cases were more likely to have exposures to cephalosporins (13.0% vs. 4.4%; P=0.02), clindamycin (5.8% vs. 0.7%; P=0.04), and outpatient healthcare settings (66.7% vs. 48.6%; P=0.01) within 30 days of illness compared with control subjects. On multivariate analysis, CA-CDI was associated with cephalosporin use within 30 days (OR 3.32; 95% CI 1.10-10.01) and the presence of a gastrointestinal feeding device (OR 2.59; 95% CI 1.07-6.30). Conclusion: A substantial proportion of children with CA-CDI did not have a "traditional" risk factor for CDI. Antibiotics are an important risk factor for CA-CDI in children with risk varying by antibiotic class. Outpatient healthcare settings may be a source of C. difficile acquisition among children in community settings.

Subject Area

Medicine|Public health

Recommended Citation

Crews, Jonathan D, "Community-associated Clostridium difficile infection in children: Characteristics and risk factors" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1566307.