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Changing Epidemiology of Clostridium difficile-Associated Disease in Children

  • Lacey Benson (a1), Xiaoyan Song (a2) (a3), Joseph Campos (a4) (a5) (a6) (a7) and Nalini Singh (a4) (a3) (a8)

Abstract

Objective.

To determine temporal trends in the incidence rate for Clostridium difficile-associated disease (CDAD) in a pediatric patient population.

Methods.

We performed an observational, retrospective cohort study that included children who visited or were admitted to Children's National Medical Center during the period from July 2001 through June 2006. The CDAD incidence rates were determined and examined for changes over time using the Poisson regression method.

Results.

A total of 513 patients whose stool specimens tested positive for C. difficile toxin were identified. Of these patients, 61% were children aged 2 years or older. The proportion of patients with CDAD in this age group has steadily increased from 46% in 2001 to 64% in 2006. Largely as a result of an increasing number of cases of community-associated CDAD, the incidence of CDAD increased significantly in the outpatient setting, particularly in the emergency department (1.18 cases per 1,000 visits in 2001 vs 2.47 cases per 1,000 visits in 2006; P = .02). The incidence among inpatients decreased during the study period (1.024 cases per 1,000 patient-days in 2001 vs 0.680 cases per 1,000 patient-days in 2006; P = .004). In the neonatal intensive care unit, C. difficile toxin was detected in stool specimens collected from 22 patients aged from 15 days to 6 months.

Conclusion.

This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children—a population that has not been considered to be at high risk for this disease in the past—are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

Copyright

Corresponding author

Epidemiology and International Health, theGeorge Washington University, Schools of Medicine and Public Health, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010 (Nsingh@cnmc.org)

References

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1.McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.
2.Pepin, J, Alary, ME, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:15911597.
3.Pepin, J, Valiquette, L, Alary, ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466472.
4.Al-Jumaili, IJ, Shibley, M, Lishman, AH, Record, CO. Incidence and origin of Clostridium difficile in neonates. J Clin Microbiol 1984;19:7778.
5.Larson, HE, Barclay, FE, Honour, P, Hill, ID. Epidemiology of Clostridium difficile in infants. J Infect Dis 1982;146:727733.
6.Han, VK, Sayed, H, Chance, GW, et al. An outbreak of Clostridium difficile necrotizing enterocolitis: a case for oral vancomycin therapy? Pediatrics 1983;71:935941.
7.Centers for Disease Control and Prevention. Severe Clostridium difficile associated disease in populations previously at low risk—four states, 2005. MMWR Morb Mortal Wkly Rep 2005;54:12011205.
8.Klein, EJ, Boster, DR, Stapp, JR, et al. Diarrhea etiology in a children's hospital emergency department: a prospective cohort study. Clin Infect Dis 2006;43:807813.
9.Johnson, S, Kent, SA, O'Leary, KJ, et al. Fatal pseudomembranous colitis associated with a variant Clostridium difficile not detected by toxin A immunoassay. Ann Intern Med 2001;135:434438.
10.Loo, VG, Miller, MA, Oughton, M, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.
11.Poutanen, S, Simor, AE. Clostridium difficile associated diarrhea in adults. CMAJ 2004;171:5158.

Changing Epidemiology of Clostridium difficile-Associated Disease in Children

  • Lacey Benson (a1), Xiaoyan Song (a2) (a3), Joseph Campos (a4) (a5) (a6) (a7) and Nalini Singh (a4) (a3) (a8)

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