April 22, 2019
1 min read

Antibiotic exposure identified as risk factor for community-acquired CDI in children

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Photo of Alice Y. Guh
Alice Y. Guh

A recent case-control study identified antibiotic use as a risk factor for community-associated Clostridioides difficile infection, or CA-CDI, in children.

“Although traditionally a health care-associated infection, CDI is increasingly spread through community acquisition. Among pediatric CDI patient cases identified through population-based surveillance, 71% to 75% were determined to be community associated,” the study authors said.

Researchers collected data from children who lived in eight of 10 geographically diverse sites where the CDC conducts population-based surveillance for the Emerging Infections Program (EIP), from October 2014 to February 2016. CDI case-patients were matched with controls in the same EIP surveillance catchment area and age group (12 to 23, 24 to 47, 48 to 60 months).

Case-patients with CA-CDI had C. difficile-positive samples, were outpatients or had been in the hospital for no more than 3 days, had not been admitted to a health care facility in the previous 12 weeks and had no history of CDI. Controls were selected randomly from birth registries or a commercial database of phone numbers, had never received a CDI diagnosis and did not have diarrheal illness or stay in a health care facility overnight in the 12 weeks before enrollment.

According to the researchers, caregivers were interviewed about relevant exposures — including medication use.

More case-patients than controls had comorbidities (33.3% vs 12.1%; P = .01), recent higher risk outpatient exposures (39.9% vs 17.7%, P = .03), used antibiotics recently (54.4% vs 19.4%; P = .0001) or were exposed to a member of their household with diarrhea (41.3% vs 21.5%; P = .04).

In a multivariable analysis, only antibiotic exposure in the 12 weeks before infection was significantly associated with CA-CDI infection (adjusted matched OR = 6.25; 95% CI, 2.18-17.96).

“We found antibiotic exposure in the preceding 12 weeks was a primary risk factor for community-associated C. difficile in young children,” Alice Y. Guh, MD, MPH, medical officer in the Division of Healthcare Quality Promotion at the CDC, told Infectious Diseases in Children. “Therefore, decreasing unnecessary outpatient antibiotic use, particularly for acute respiratory tract infections, might reduce community-associated C. difficile infection in this population.”by Erin Michael

Disclosures: Guh reports no relevant financial disclosures. One of the authors reports serving on the drug safety monitoring board for a C. difficile treatment study by Seres.