Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

Abstract

OBJECTIVE: Little is known about the epidemiology of Clostridium difficile infection (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.

Differences in the Molecular Epidemiology and Antibiotic Susceptibility of Clostridium difficile Isolates in Pediatric and Adult Patients

“…For example, we previously reported antibiotic exposure in the previous 30 days among 26% of children with CA-CDI (compared to 88% of children with hospital-onset health care facility-associated [HO-HCFA] CDI), and Tschudin-Sutter et al reported antibiotic exposure in the previous 30 days among 42% of children with CA-CDI (compared to 76% of children with HCFA-CDI). Furthermore, we previously reported that CA-CDI is the most common type of CDI in a pediatric cohort (11), and other population-based studies support this; CA-CDI accounted for 60% to 80% of CDIs, depending on age, in a U.S. surveillance study (24) and for 75% of cases in a population-based study in Minnesota (25). Thus, because of the predominance of CA-CDI in children and the relatively infrequent rate of antibiotic exposure preceding CA-CDI in children, this may account for the favorable susceptibility profile among our pediatric isolates.…”

Diagnosis of Clostridium difficile Infections in Children

“…Historically, outpatient populations have been thought to be at lower risk of CDI. In a laboratory-based surveillance study by Wendt et al, the rate of C. difficile detection from testing of children in the community was 71% (26). However, this study and others have not correlated the positive laboratory findings with clinical data, making the link between a positive test and the causality of disease unclear (5).…”

Fecal microbiota transplantation in children: a brief review

“…The prevalence of CDI in children is increasing (17), with the highest CDI incidence among children 1 to 4 y of age (18). Recurrence of CDI can occur in 20-30% after initial infection, with the frequency of recurrence rising further after subsequent infections (19)(20)(21).…”