March 21, 2013
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Community-acquired cases drive rise in C. difficile infection among children

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Clostridium difficile infection has increased significantly among children in the last two decades with the majority of incidence being community-acquired cases, according to study data.

Researchers conducted a population-based cohort study of C. difficile infection (CDI) among children aged 0 to 18 years in Olmstead County, Minn., based on the Rochester Epidemiology Project resources. The study, held from 1991 through 2009, collected data on incidence, severity, treatment response and outcomes. Ninety-two patients (median age, 2.3 years; 50 boys) had CDI diagnoses.

Although community-acquired cases accounted for 75% of incidence, “severe infection was more common in hospital-acquired cases,” researcher Sahil Khanna, MBBS, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., told Healio.com. “In children who have diarrhea, C difficile should be considered as a differential diagnosis.”

During the study period, overall age- and sex-adjusted CDI incidence was 13.8 cases per 100,000 person-years. Rates rose from 2.6 (1991-1997) to 5.7 (1998-2003) to 32.6 per 100,000 person-years (2004-2009), a 12.5-fold increase (P<.0001).

In community-acquired CDI, overall incidence was 10.3 cases per 100,000 person-years and increased more than 10-fold from 2.2 per 100,000 person-years (1991-1997) to 23.4 per 100,000 person-years (2004-2009) (P<.0001). Children aged 0 to 1 year had the greatest CDI incidence at 43.6 per 100,000 person-years.

Of the 69 patients with community-acquired CDI, nine required hospitalization. Metronidazole was the initial treatment in 81.5% of cases, and 18% of patients experienced treatment failure. Researchers did not observe treatment failure among 7.6% of patients who received oral vancomycin therapy.

“CDI was uncommon in children from 1991 through 2009, although there was a significant increase in cases after 2006,” the researchers concluded. “A substantial fraction of cases occurred in patients managed as outpatients, which would have been missed if hospitalized children were the only identified cohort. Such an omission of community-acquired cases could result in an underestimation of disease incidence and overestimation of disease severity in children with CDI.”