First name
Julia
Middle name
Shaklee
Last name
Sammons

Title

Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children.

Year of Publication

2013

Number of Pages

1-8

Date Published

2013 Jul

ISSN Number

1537-6591

Abstract

<p><strong>BACKGROUND: </strong>Clostridium difficile infection (CDI) is associated with significant morbidity and mortality among adults. However, outcomes are poorly defined among children.</p>

<p><strong>METHODS: </strong>A retrospective cohort study was performed among hospitalized children at 41 children's hospitals between January 2006 and August 2011. Patients with CDI (exposed) were matched 1:2 to patients without CDI (unexposed) based on the probability of developing CDI (propensity score derived from patient characteristics). Exposed subjects were stratified by C. difficile test date, suggestive of community-onset (CO) versus hospital-onset (HO) CDI. Outcomes were analyzed for matched subjects.</p>

<p><strong>RESULTS: </strong>We identified 5107 exposed and 693 409 unexposed subjects. Median age was 6 years (interquartile range [IQR], 2-13 years) for exposed and 8 years (IQR, 3-14 years) for unexposed subjects. Of these, 4474 exposed were successfully matched to 8821 unexposed by propensity score. In-hospital mortality differed significantly (CDI, 1.43% vs matched unexposed, 0.66%; P &lt; .001). Mortality rates were similar between CO-CDI and matched subjects. However, mortality rates were significantly greater among HO-CDI compared with matched unexposed (odds ratio, 6.73 [95% confidence interval {CI}, 3.77-12.02]). Mean differences in length of stay (LOS) and total cost were significant: 5.55 days (95% CI, 4.54-6.56 days) and $18 900 (95% CI, $15 100-$22 700) for CO-CDI, and 21.60 days (95% CI, 19.29-23.90 days) and $93 600 (95% CI, $80 000-$107 200) for HO-CDI.</p>

<p><strong>CONCLUSIONS: </strong>Pediatric CDI is associated with increased mortality, longer LOS, and higher costs. These findings underscore the importance of antibiotic stewardship and infection control programs to prevent this disease in children.</p>

DOI

10.1093/cid/cit155

Alternate Title

Clin. Infect. Dis.

PMID

23532470

Title

Clostridium difficile Infection in children.

Year of Publication

2013

Number of Pages

567-73

Date Published

2013 Jun

ISSN Number

2168-6211

Abstract

<p>Clostridium difficile is the most common cause of health care-associated diarrhea among adults in the United States and is associated with significant morbidity and mortality. During the past decade, the epidemiology of C difficile infection (CDI) has changed, including a rise in the rate and severity of infection related to the emergence of a hypervirulent strain as well as an increase in disease among outpatients in community settings. Although less is known about CDI among pediatric patients, C difficile is increasingly recognized as an important pathogen among children. In this review, we discuss recent updates in the incidence and epidemiology of CDI among children, including risk factors for infection, and highlight the importance of CDI in special populations of children, particularly those with inflammatory bowel disease or cancer. In addition, we review current knowledge in the areas of diagnosis and management of CDI among children and highlight future areas for research.</p>

DOI

10.1001/jamapediatrics.2013.441

Alternate Title

JAMA Pediatr

PMID

23460123

Title

Present or absent on admission: Results of changes in National Healthcare Safety Network surveillance definitions.

Year of Publication

2015

Number of Pages

1128-30

Date Published

2015 Oct 1

ISSN Number

1527-3296

Abstract

<p>In January 2013, the National Healthcare Safety Network definition of "present on admission" was created. Using existing surveillance data from 2013, we identified health care-associated infections (HAIs) that met prior present on admission criteria but not the new definition. We identified a number of infections classified as HAI despite evidence that infection was clinically present on admission. These findings have important implications for states with mandatory HAI reporting using National Healthcare Safety Network definitions.</p>

DOI

10.1016/j.ajic.2015.05.023

Alternate Title

Am J Infect Control

PMID

26129843

Title

Risk Factors for In-Hospital Mortality among a Cohort of Children with Clostridium difficile Infection.

Year of Publication

2015

Number of Pages

1183-9

Date Published

2015 Oct

ISSN Number

1559-6834

Abstract

<p>OBJECTIVE The incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI. METHODS A multicenter cohort of children with CDI, aged 1-18 years, was established among children hospitalized at 41 freestanding children's hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model. RESULTS We identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2-13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7-20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40-3.77)], underlying malignancy [3.57 (2.36-5.40)], cardiovascular disease [2.06 (1.28-3.30)], hematologic/immunologic condition [1.89 (1.05-3.39)], gastric acid suppression [2.70 (1.43-5.08)], and presence of &gt;1 severity of illness marker [3.88 (2.44-6.19)]. CONCLUSION Patients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies. Infect Control Hosp Epidemiol 2015;36(10):1183-1189.</p>

DOI

10.1017/ice.2015.152

Alternate Title

Infect Control Hosp Epidemiol

PMID

26135055

WATCH THIS PAGE

Subscription is not available for this page.