Skip to main content Accessibility help
×
Home

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

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

Hide All
1.Magill, SS et al. (2014) Multistate point-prevalence survey of health care-associated infections. The New England Journal of Medicine 370, 11981208.
2.Cherry, J et al. (2013) Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 7th Edn. Philadelphia, PA: Saunders Elsevier.
3.McDonald, LC et al. (2018) Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases 66, e1e48.
4.Kim, J et al. (2008) Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001–2006. Pediatrics 122, 12661270.
5.Zilberberg, MD, Tillotson, GS and McDonald, C (2010) Clostridium difficile infections among hospitalized children, United States, 1997–2006. Emerging Infectious Diseases 16, 604609.
6.Zilberberg, MD, Shorr, AF and Kollef, MH (2008) Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000–2005. Emerging Infectious Diseases 14, 929931.
7.Sammons, JS et al. (2013) Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children. Clinical Infectious Disease 57, 18.
8.Dubberke, ER et al. (2008) Short- and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clinical Infectious Disease 46, 497504.
9.Dubberke, ER et al. (2008) Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients. Emerging Infectious Diseases 14, 10311038.
10.Mehrotra, P et al. (2017) Attributable cost of Clostridium difficile infection in pediatric patients. Infection Control and Hospital Epidemiology 38, 14721477.
11.Tullus, K et al. (1989) Intestinal colonization with Clostridium difficile in infants up to 18 months of age. European Journal of Clinical Microbiology & Infectious Diseases 8, 390393.
12.Jangi, S and Lamont, JT (2010) Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. Journal of Pediatric Gastroenterology and Nutrition 51, 27.
13.Wendt, JM et al. (2014) Clostridium difficile infection among children across diverse U.S. geographic locations. Pediatrics 133, 651658.
14.Baker, SS et al. (2010) Increasing incidence of community-associated atypical Clostridium difficile disease in children. Clinical Pediatrics 49, 644647.
15.Benson, L et al. (2015) Changing epidemiology of Clostridium difficile-associated disease in children. Infection Control and Hospital Epidemiology 28, 12331235.
16.Lessa, FC et al. (2015) Burden of Clostridium difficile infection in the United States. The New England Journal of Medicine 372, 825834.
17.Khanna, S et al. (2013) The epidemiology of Clostridium difficile infection in children: a population-based study. Clinical Infectious Disease 56, 14011406.
18.Adams, DJ et al. (2017) Risk factors for community-associated Clostridium difficile infection in children. The Journal of Pediatrics 186, 105109.
19.Crews, JD et al. (2015) Risk factors for community-associated Clostridium difficile-associated diarrhea in children. The Pediatric Infectious Disease Journal 34, 919923.
20.Chitnis, AS et al. (2013) Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Internal Medicine 173, 13591367.
21.Guh, AY et al. (2017) Risk factors for community-associated Clostridium difficile infection in adults: a case-control study. Open Forum Infectious Diseases 4, ofx171.
22.Sandora, TJ et al. (2011) Epidemiology and risk factors for Clostridium difficile infection in children. The Pediatric Infectious Disease Journal 30, 580584.
23.Hersh, AL et al. (2011) Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 128, 10531061.
24.Hersh, AL et al. (2016) Frequency of first-line antibiotic selection among us ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Internal Medicine 176, 18701872.
25.Gerber, JS et al. (2015) Variation in antibiotic prescribing across a pediatric primary care network. Journal of the Pediatric Infectious Diseases Society 4, 297304.
26.Kuntz, JL et al. (2011) Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study. BMC Infectious Diseases 11, 194.
27.Hensgens, MPM et al. (2012) Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. The Journal of Antimicrobial Chemotherapy 67, 742748.
28.Tschudin-Sutter, S et al. (2013) Distinguishing community-associated from hospital-associated Clostridium difficile infections in children: implications for public health surveillance. Clinical Infectious Disease 57, 16651672.
29.Johnson, CL and Versalovic, J (2012) The human microbiome and its potential importance to pediatrics. Pediatrics 129, 950960.
30.Penders, J et al. (2006) Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118, 511521.
31.Holzbauer, S et al. (2013) Evaluating the presence of Clostridium difficile in the household environment and its role in disease transmission, Minnesota, 2011–2012 [abstract 1378]. Poster presented at: IDWeek 2013; San Francisco, CA.
32.Loo, VG et al. (2016) Household transmission of Clostridium difficile to family members and domestic pets. Infection Control and Hospital Epidemiology 37, 13421348.
33.Shaughnessy, MK et al. (2016) Environmental contamination in households of patients with recurrent Clostridium difficile infection. Applied and Environmental Microbiology 82, 26862692.
34Centers for Disease Control and Prevention. Clostridium difficile Infection Information for Patients. Available at https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html (Accessed 6 April 2018).

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed