Pediatrics

Children in US hospitals are becoming infected with Clostridium difficile more frequently than ever, according to an online published report.

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 charges.

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 infection.

This study was supported by a grant from the Agency for Healthcare Research and Quality.

Disclosure: The researchers report no relevant financial disclosures.

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

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