Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

• Article

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

1. Joyanna M. Wendt, MD, MPH^a,^b, 
2. Jessica A. Cohen, MPH^a,^c, 
3. Yi Mu, PhD^a, 
4. Ghinwa K. Dumyati, MD^d, 
5. John R. Dunn, DVM, PhD^e,
6. Stacy M. Holzbauer, DVM, MPH^f,^g, 
7. Lisa G. Winston, MD^h,
8. Helen L. Johnston, MPHⁱ, 
9. James I. Meek, MPH^j, 
10. Monica M. Farley, MD^k,^l, 
11. Lucy E. Wilson, MD, ScM^m, 
12. Erin C. Phipps, DVM, MPHⁿ,
13. Zintars G. Beldavs, MS^o, 
14. Dale N. Gerding, MD^p,^q,
15. L. Clifford McDonald, MD^a, 
16. Carolyn V. Gould, MD, MSCR^a, and
17. Fernanda C. Lessa, MD, MPH^a

+Author Affiliations

1. ^aDivision of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases
2. ^bEpidemic Intelligence Service, Office of Surveillance Epidemiology and Laboratory Services, and
3. ^fOffice of Public Health Preparedness and Response, Career Epidemiology Field Office Program, Centers for Disease Control and Prevention, Atlanta, Georgia;
4. ^cAtlanta Research and Education Foundation, Atlanta, Georgia;
5. ^dDepartment of Medicine, University of Rochester Medical Center, Rochester, New York;
6. ^eTennessee Department of Health, Nashville, Tennessee;
7. ^gDepartment of Medicine, Minnesota Department of Health, St Paul, Minnesota;
8. ^hUniversity of California, San Francisco, School of Medicine, San Francisco, California;
9. ⁱColorado Department of Public Health and Environment, Denver, Colorado;
10. ^jYale School of Public Health, Connecticut Emerging Infections Program, New Haven, Connecticut;
11. ^kDepartment of Medicine, Emory University School of Medicine, Atlanta, Georgia;
12. ^lAtlanta Veterans Affairs Medical Center, Atlanta, Georgia;
13. ^mMaryland Department of Health and Mental Hygiene, Baltimore, Maryland;
14. ⁿEmerging Infections Program, University of New Mexico, Albuquerque, New Mexico;
15. ^oOregon Health Authority, Public Health Division, Portland, Oregon;
16. ^pDepartment of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; and
17. ^qEdward Hines Jr Veterans Affairs Hospital, Hines, Illinois

ABSTRACT

OBJECTIVE: Little is known about the epidemiology of Clostridium difficileinfection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups.

METHODS: Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010–2011 were used to identify cases (ie, residents with C difficile–positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years.

RESULTS: Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100 000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks.

CONCLUSIONS: Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.

Key Words:

• Clostridium difficile
 
• pediatric
 
• community-associated
• antimicrobial stewardship

• Accepted January 3, 2014.

• Copyright © 2014 by the American Academy of Pediatrics