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Risk factors for community-associated Clostridioides difficile infection in young children

  • M. K. Weng (a1), S. H. Adkins (a1), W. Bamberg (a2), M. M. Farley (a3) (a4) (a5), C. C. Espinosa (a4) (a5), L. Wilson (a6), R. Perlmutter (a6), S. Holzbauer (a7) (a8), T. Whitten (a7), E. C. Phipps (a9), E. B. Hancock (a9), G. Dumyati (a10), D. S. Nelson (a10), Z. G. Beldavs (a11), V. Ocampo (a11), C. M. Davis (a12), B. Rue (a12), L. Korhonen (a1), L. C. McDonald (a1) and A. Y. Guh (a1)...

Abstract

The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.

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Copyright

COPYRIGHT: © The Author(s) 2019
This is a work of the U.S. Government and is not subject to copyright protection in the United States.This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: A. Y. Guh, E-mail: ggt4@cdc.gov

References

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