Improving Surveillance for Pediatric Clostridium difficile Infection

Shaklee, Julia; Zerr, Danielle M.; Elward, Alexis; Newland, Jason G.; Leckerman, Kateri H.; Asti, Lindsey; Guth, Rebecca M.; Bass, Julie; Selvarangan, Rangaraj; Coffin, Susan; Zaoutis, Theoklis E.

doi:10.1097/inf.0b013e3182027c22

Cited by 35 publications

(9 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This definition of CDI has been previously validated in an inpatient setting with a positive predictive value of 83.0% and a negative predictive value of 99.9%. (13) HA-CDI was defined as CDI that occurred after at least 6 inpatient days.…”

Section: Methodsmentioning

confidence: 99%

Trends in Clostridium difficile Infection and Risk Factors for Hospital Acquisition of Clostridium difficile among Children with Cancer

Blank

Zaoutis

Fisher

et al. 2013

The Journal of Pediatrics

Self Cite

View full text Add to dashboard Cite

Objectives To study the trend of Clostridium difficile infection (CDI) and risk factors for hospital acquired CDI (HA-CDI) among children with cancer. Study design We analyzed 33,095 first pediatric hospitalizations for malignancy among 43 pediatric hospitals between 1999 and 2011. The effect of demographics, disease characteristics, and weekly drug exposure (antibiotics, antacids and chemotherapy) on HA-CDI was assessed with multivariate Cox regression. CDI was defined by the combination of ICD-9CM code, CDI diagnostic assay billing code and concurrent administration of a CDI-active antibiotic. HA-CDI was defined as CDI with assay occurring after the 6th hospital day. Results 1,736 admissions with CDI were identified, of which 380 were HA-CDI. CDI incidence increased from 1999–2006 (p=0.01); however, CDI testing frequency and disease decreased from 2006–2010 (p<0.05). Admissions with HA-CDI had longer lengths of stay compared with those without HA-CDI (35days vs. 12days, p<0.01) and greater risk of inpatient mortality (RR 2.3, p<0.01). Increased risk of HA-CDI (hazard ratio [95% confidence interval]) was seen after exposure to the following drugs: aminoglycoside (1.357 [1.053 – 1.749]), third generation cephalosporin (1.518 [1.177 – 1.959]), cefepime (2.383 [1.839 – 3.089]), and proton pump inhibiting agent (1.398 [1.096 – 1.784]) in the prior week, and chemotherapy in the 8–14 days prior to HA-CDI onset (1.942 [1.491 – 2.529]). Histamine-2 receptor antagonist exposure in the prior week was associated with decreased risk of HA-CDI (0.730 [0.584 – 0.912]). Conclusions Despite an apparent decrease in CDI incidence from 2006–2010, HA-CDI remains prevalent and morbid among children with cancer. Recent exposure to chemotherapy, proton pump inhibitor, and certain antibiotics were independent risk factors for HA-CDI.

show abstract

Section: Methodsmentioning

confidence: 99%

Trends in Clostridium difficile Infection and Risk Factors for Hospital Acquisition of Clostridium difficile among Children with Cancer

Blank

Zaoutis

Fisher

et al. 2013

The Journal of Pediatrics

Self Cite

View full text Add to dashboard Cite

show abstract

“…There is limited information on CDI colonization vs true infection, as the data are based on ICD-9 codes. Nevertheless, the ICD-9-CM code for CDI diagnosis has been validated in previous studies, and has been shown to correlate well with the results of C. difficile toxin assay [30, 31]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes in children withClostridium difficileinfection: results from a nationwide survey

Gupta

Pardi

Baddour

et al. 2016

Gastroenterol. Rep.

View full text Add to dashboard Cite

Objective: Hospital- and population-based studies demonstrate an increasing incidence of Clostridium difficile infection (CDI) in adults and children; although pediatric CDI outcomes are incompletely understood. We analysed United States National Hospital Discharge Survey (NHDS) data to study CDI in hospitalized children.Methods: NHDS data for 2005–2009 (demographics, diagnoses and discharge status) were obtained; cases and comorbidities were identified using ICD-9 codes. Weighted univariate and multivariate analyses were performed to ascertain incidence of CDI; associations between CDI and outcomes [length of stay (LOS), colectomy, all-cause in-hospital mortality and discharge to a care facility (DTCF)].Results: Of an estimated 13.8 million pediatric inpatients; 46 176 had CDI; median age was 3 years; overall incidence was 33.5/10 000 hospitalizations. The annual frequency of CDI did not vary from 2005 to 2009 (0.24–0.43%; P = 0.64). On univariate analyses, children with CDI had a longer median LOS (6 vs 2 days), higher rates of colectomy [odds ratio (OR) 2.0; 95% confidence interval (CI) 1.7–2.4], mortality (OR 2.5; 95% CI 2.3–2.7), and DTCF (OR 1.6; 95% CI 1.6–1.7) (all P < 0.0001). After adjusting for age, sex and comorbidities, CDI was an independent and the strongest predictor of increased LOS (adjusted mean difference, 6.4 days; 95% CI 5.4–7.4), higher rates of colectomy (OR 2.1; 95% CI 1.8–2.5), mortality (OR 2.3; 95% CI 2.2–2.5), and DTCF (OR 1.7; 95% CI 1.6–1.8) (all P < 0.0001). On excluding infants from the analysis, children with CDI had higher rates of mortality, DTCF and longer LOS than children without CDI.Conclusions: Despite increased awareness and advancements in management, CDI remains a significant problem and is associated with increased LOS, colectomy, in-hospital mortality and DTCF in hospitalized children.

show abstract

“…We screened for children with CDI using the International Classification of Diseases, Ninth Revision (ICD-9) code 008.45 (previously validated for CDI in hospitalized children 20 ) and/or positive test results for C difficile . We confirmed CDI by record review as having diarrhea (≥3 loose stools/day) and either a positive C difficile stool test (toxin assay or polymerase chain reaction [PCR] test, the latter used more routinely in study centers since 2011) or gross pseudomembranous colitis, per Society for Healthcare Epidemiology of America surveillance criteria.…”

Section: Methodsmentioning

confidence: 99%

“…This definition has greater specificity for CDI than using diagnostic codes or test results alone. 20 Cases of CDIAReA included in incidence calculations were confirmed by record review to be in the source population and have both CDI diagnosis code and positive test results. We examined trends in CDIAReA incidence using linear regression and adjusted for changes in CDI incidence.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology ofClostridium difficileInfection–Associated Reactive Arthritis in Children

et al. 2016

View full text Add to dashboard Cite

IMPORTANCEThe incidence of Clostridium difficile infection has increased among children. The epidemiology of pediatric C difficile infection-associated reactive arthritis is poorly understood.OBJECTIVE To characterize the incidence, recognition, and distinguishing clinical features of pediatric C difficile infection-associated reactive arthritis among children with C difficile infection. DESIGN, SETTING, AND PARTICIPANTSIn this cohort and nested case-control study using electronic health records from January 1, 2004, to December 31, 2013, across 3 geographically diverse pediatric health care networks, we screened for reactive arthritis among 148 children between ages 2 and 21 years with diagnostic or procedural codes suggesting musculoskeletal disease associated with C difficile diagnosis or positive testing. We identified 26 cases with acute arthritis or tenosynovitis within 4 weeks before to 12 weeks after confirmed C difficile infection with (1) no alternative explanation for arthritis and (2) negative synovial cultures (if obtained). Network-matched C difficile-infected controls without arthritis were randomly selected at the time of cohort member C difficile infections. MAIN OUTCOMES AND MEASURESIncidence of C difficile infection-associated reactive arthritis was calculated based on (1) pediatric source population and (2) children with C difficile infection. Characteristics of cases and controls were compared using conditional logistic regression. RESULTSBased on the cases identified within the source population of the 3 hospital networks, we estimated that C difficile infection-associated reactive arthritis incidence was 5.0 cases per million person-years (95% CI, 3.0-7.8). Reactive arthritis affected 1.4% of children with C difficile infection yearly (95% CI 0.8%-2.3%). Joint symptoms began a median of 10.5 days after initial gastrointestinal symptoms, often accompanied by fever (n = 15 [58%]) or rash (n = 14 [54%]). Only 35% of cases of C difficile infection-associated reactive arthritis were correctly diagnosed by treating health care professionals (range across centers, 0%-64%). Five affected children (19%) were treated for presumed culture-negative septic hip arthritis despite having prior postantibiotic diarrhea and/or other involved joints. Compared with controls, cases of C difficile infection-associated reactive arthritis were less likely to have underlying chronic conditions (odds ratio [OR], 0.3; 95% CI, 0.1-0.8). Although all cases had community-onset C difficile infection and fewer comorbidities, they were more likely to be treated in emergency departments and/or hospitalized (OR, 7.1; 95% CI, 1.6-31.7).CONCLUSIONS AND RELEVANCE C difficile infection-associated reactive arthritis is an underdiagnosed, potentially morbid reactive arthritis associated with C difficile infection occasionally misdiagnosed as septic arthritis. Given the rising incidence of pediatric C difficile infections, better recognition of its associated reactive arthritis is needed.

show abstract

Improving Surveillance for Pediatric Clostridium difficile Infection

Abstract: These results demonstrate that the use of administrative data for CDI is a reliable and accurate method for identifying pediatric patients with CDI. The use of administrative data could facilitate the completion of larger studies due to its greater accessibility and reduced costs.

Cited by 35 publications

References 13 publications

Trends in Clostridium difficile Infection and Risk Factors for Hospital Acquisition of Clostridium difficile among Children with Cancer

Trends in Clostridium difficile Infection and Risk Factors for Hospital Acquisition of Clostridium difficile among Children with Cancer

Outcomes in children withClostridium difficileinfection: results from a nationwide survey

Epidemiology ofClostridium difficileInfection–Associated Reactive Arthritis in Children

Contact Info

Product

Resources

About