Clostridium difficile Infection in Hospitalized Children in the United States

Nylund, Cade M.; Goudie, Anthony; Garza, Jose M.; Fairbrother, Gerry; Cohen, Mitchell B.

doi:10.1001/archpediatrics.2010.282

Cited by 186 publications

(170 citation statements)

References 47 publications

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“…20 This method has previously been used in evaluating disease outcomes for other hospital-acquired infections. [21][22][23] VRE infection was the dependent variable, and demographic variables, hospital/ geographic variables, and 389 of the most common comorbid diagnostic and procedure CCS codes, as discussed previously, were the independent variables in the model. Patients with an indication of VRE infection (cases) were matched by high-dimensional propensity score, using a greedy matching algorithm, to patients who did not have VRE (controls), with a 1-to-5 matching ratio.…”

Section: Discussionmentioning

confidence: 99%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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A B S T R A C T OBJECTIVE:Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. METHODS:A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. RESULTS: Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizationsper million in 1997 to 120 in 2012 (P , .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P , .001) and higher hospitalization costs (AD $8233, P 5 .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47).CONCLUSIONS: VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.

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Section: Discussionmentioning

confidence: 99%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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“…1 Nylund et al evaluated data from 1997, 2000, 2003, and 2006 and demonstrated an increase in the number of CDIs, from 3565 cases in 1997 to 7779 cases in 2006 (total cases, 21 274; P < .01). 2 Zilberberg et al also demonstrated an increase of hospitalizations attributable to C difficile, from 7.24 to 12.80/10 000 hospitalizations. 3 The emergence of the epidemic strain of toxin-producing C difficile (North American pulsed field type 1 [NAP1]) in recent years may have changed the epidemiology in children.…”

Section: Introductionmentioning

confidence: 91%

“…[1][2][3] Kim et al evaluated the annual incidence of C difficile-associated disease from 2001 to 2006 at 22 freestanding children' s hospitals and found increases in the number of admissions (2.4 to 4.0/1000 admissions; P = .04) as well as the number of cases per patient-days in the hospital (4.4 to 6.5 cases/10 000 patient-days; P = .06). 1 Nylund et al evaluated data from 1997, 2000, 2003, and 2006 and demonstrated an increase in the number of CDIs, from 3565 cases in 1997 to 7779 cases in 2006 (total cases, 21 274; P < .01).…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile Infection in Infants and Children

Schutze¹,

Willoughby²

2013

Pediatrics

226

100

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Infections caused by Clostridium difficile in hospitalized children are increasing. The recent publication of clinical practice guidelines for C difficile infection in adults did not address issues that are specific to children. The purpose of this policy statement is to provide the pediatrician with updated information and recommendations about C difficile infections affecting pediatric patients. Pediatrics

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“…Even if the burden of disease regards the adult age, a concomitant increase of number of hospitalizations, hospital length of stay, medical expenses, colectomy rate for CDI have been reported also in children [8,9]. In spite of this phenomenon, CDI infection is rarely severe at this age, and severity is strongly related to the presence of multiple antibiotic courses [4].…”

Section: Exploding or Rare Disease?mentioning

confidence: 99%

“…Of interest, both hospital (HA) -and community (CA) -associated CDI are increasing [9], but while in HA-CDI the above mentioned risk factors are usually found, these factors are often lacking in CA-CDI [10], where the main determinant factor is the presence of comorbidities and among these of inflammatory bowel disease (IBD) [6][7][8][9].…”

Section: Exploding or Rare Disease?mentioning

confidence: 99%

Clostridium Difficile in Children- A Multifaceted Infection

Giacomo¹,

Borali²

2016

Pediatric Infect Dis

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Two case reports of children with muco-hemorrhagic diarrhea positive for Clostridium difficile introduce into the world of Clostridium difficile infection in the pediatric age. Epidemiological, clinical, and microbiological findings represent pieces of the puzzle of one of the most emerging infections at all the ages. Keywords: CommentaryTwo children were referred to our Pediatric Gastroenterology Unit for muco-hemorrhagic diarrhea. Patient 1:The first one was a 13-month-old boy, with a medical history started since the third trimester of pregnancy when a moderate bilateral dilation of urinary tract was demonstrated at ultrasonography. After a normal delivery he underwent to recurrent episodes of urinary tract infections caused by E.coli and treated with amoxicillin when, at age of 6 months, a urinary cistography showed a 3rd degree bilateral vesicouretheral reflux. At 9 months of age, he developed fever, vomiting and diarrhoea, and he was treated with IV cephalosporin for pyelonephritis. Successively, a prophylactic therapy with amoxicillin was started. Two months later, when he was 1-year-old, he developed progressively irritability, feeding refusal, associated with failure to thrive; an urine analysis showed the presence of an infection by E.coli resistant to amoxicillin and iv cephalosporin therapy was administrated at home. After a few days of clinical improvement, the reappearance of symptoms suggested to refer the child to a Hospital, where gentamicin was added to treatment. Five days later, a picture of mild diarrhoea appeared, and stools analysis for common viral and bacterial pathogens, revealed the presence of Rotavirus infection. Three days later, diarrhoea increased with progressive appearance of mucous and blood, fever and worsening of general conditions. For this reason the child was referred to our Hospital, where he arrived febrile (39 degrees Celsius of temperature), with mild dehydration , dilated abdomen, 5 to 7 muco-hemorrhagic evacuations daily, and laboratory evidence of leukocytosis (16000/mmc), and raised serum CRP (9.1 mg/L; n.v. <0.5 mg/L) . Urine, blood and faecal cultures were negative, but a search for toxigenic Clostridium difficile (CD) came back positive suggesting a presumptive diagnosis of Clostridium difficile infection (CDI). Discontinuation of cephalosporin and gentamicin and prompt administration of oral metronidazole (25-30 mg/kg/day qid x 10 days) induced an amelioration of clinical picture within 36 hours with complete remission after 3 days of such a treatment. Patient 2:The second patient was a 14-year-old girl, without any significant clinical history, who developed a severe diarrhoea with more than 8 loose stools for day with mucous and blood, fever and abdominal pain. Laboratory analysis showed anaemia (8.3 g/dl), thrombocytosis (580000/mmc), raised ESR (75 mm/hr) and CRP (7 mg/L; n.v. <0.5 mg/L), and the presence of toxigenic C. difficile in the stools. A treatment with metronidazole alone first and combined with IV later, didn't improve the clinical pictu...

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Clostridium difficile Infection in Hospitalized Children in the United States

Abstract: To evaluate the trend in Clostridium difficile infection (CDI) among hospitalized children in the United States and to evaluate the severity of and risk factors associated with these cases of CDI.

Cited by 186 publications

References 47 publications

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Clostridium difficile Infection in Infants and Children

Clostridium Difficile in Children- A Multifaceted Infection

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