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Master of Public Health

Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013-2019

AUTHORS

Edwards PT , Thurm CW , Hall M , Busing JD , Kahn SA , Kellermayer R , Kociolek LK , Oliva-Hemker MM , Sammons JS , Weatherly M , Edwards KM , Nicholson MR , . The Journal of pediatrics. 2022 8 23; ().

ABSTRACT

OBJECTIVES: To compare the incidence, epidemiology, testing patterns, treatment and outcomes of Clostridioides difficile infection (CDI) among hospitalized pediatric patients from 2013-2019.

STUDY DESIGN: The Pediatric Health Information System® (PHIS) database was queried for patient admissions (age 0-17 years) with International Classification of Disease (ICD) 9 and 10 codes for diagnoses of CDI with a billing code for a CDI-related antibiotic treatment.

RESULTS: 17,142 pediatric patients were identified, representing 23,052 admissions with CDI. Adjusted annual CDI incidence decreased over the study period from 7.09 cases per 10,000 patient days (95% CI: 6.15 – 8.18) in 2013 to 4.89 cases per 10,000 patient days (95% CI: 4.03 – 5.93) in 2019 (p<0.001). C. difficile specific testing also decreased during the study period (p<0.001). Chronic gastrointestinal conditions (36%) and malignancy (32%) were the most common comorbidities in CDI encounters. Oral metronidazole use decreased during the study period (p<0.01) and oral vancomycin use increased (p<0.001).

CONCLUSIONS: Our study demonstrates a decrease in CDI incidence in hospitalized pediatric patients, a notable change from prior studies, although this may have been influenced by altered testing patterns. We found a high incidence of CDI in patients with cancer and gastrointestinal conditions: groups that warrant targeted evaluation of CDI prevention and treatment.

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