Nylund CM. Arch Pediatr Adolesc Med.
Children in US hospitals are becoming infected with Clostridium
difficile more frequently than ever, according to an online published
Some patients with C. difficile infection have no symptoms, but
others develop diarrhea, toxic megacolon, perforated bowels or other
potentially fatal complications, according to the study, which will appear in
the May print issue of Archives of Pediatrics & Adolescent Medicine.
“In recent years, the incidence of C difficile infection,
number of hospitalizations, associated deaths and severity in adults have been
increasing,” the researchers wrote.
To evaluate the trends of C. difficile infection in children,
Cade M. Nylund, MD, of Uniformed Services University of the Health
Sciences, Bethesda, Md., and colleagues analyzed records of hospitalized
children in a national database of patients discharged from the hospital in
1997, 2000, 2003 and 2006. The database included about 10.5 million patients,
of whom 21,274 (0.2%) had
C. difficile infection.
The number of cases increased about 15% each year, from 3,565 in 1997 to
7,779 in 2006. Children with C. difficile infection had an increased
risk for death or colectomy, longer hospital stays and higher hospitalization
Some children appeared more likely to become infected, including those
who were white, lived in the West or in urban areas, had private insurance or
had other comorbid conditions, such as inflammatory bowel disease. The risk for
infection was lower among black or Hispanic children, those who lived in the
South, those admitted to rural hospitals, those with Medicaid/Medicare
insurance and those who had self-pay or no-pay insurance status.
In contrast to recent trends in adults, however, the researchers did not
observe an increase in severity over time among children infected with C.
difficile. The increased risk for C. difficile infection may be
caused by a widespread dissemination of a more virulent strain of the bacteria,
according to the researchers.
“There may also be increasing awareness among
health care providers, leading to increased testing in
symptomatic patients,” they wrote. “The population-based data in our
study provide additional evidence that C difficile infection cases have
a significant effect on the pediatric population.”
The researchers concluded that this study supports previous reports that
C. difficile infection is increasing among hospitalized children. It
also provides a background for understanding changing trends and risk factors
of C. difficile infection in children. Increasing awareness of these
risk factors and of an upward trend in hospitalized children with C.
difficile infection is the first step in controlling this important
This study was supported by a grant from the Agency for Healthcare
Research and Quality.
Disclosure: The researchers report no relevant financial
There are three factors relating to increasing rates of CDI: growing size of population with debility and immunosuppression; altered intestinal microbiota with antibiotics and other drugs; and, exposure to spores and vegetative cells of C. difficile. CDI is moving into pediatric populations because of the increasing numbers of children with associated illness such as inflammatory bowel disease and possibly because of increasing virulence of C. difficile strains. As in adults onset of diarrhea in a hospital confined child receiving antibiotics should be evaluated for the presence of CDI.
- Herbert L. DuPont, MD
Infectious Disease News Editorial Board member