Child/Adolescent Health

Clostridium difficile infection rate has risen among hospitalized children since late 1990s

The number of cases of Clostridium difficile infection (CDI) among hospitalized children in the United States more than doubled over a 10-year period, according to a new study. A bacterium that can colonize the gastrointestinal tract, C. difficile can cause symptoms ranging from nothing to severe diarrhea, inflammation of the colon, bowel perforation, and even death. The researchers found that the incidence of CDI in hospitalized children increased from 3,565 cases in 1997 to 7,779 cases in 2006.
Children with CDI had a 20 percent greater risk of death and a 36 percent higher risk of requiring surgery to remove part of or the entire colon. In addition, children diagnosed with CDI were four times more likely to have an extended hospital stay and twice as likely to have higher hospital costs than hospitalized children not infected by C. difficile.
The researchers found no trend in the severity of CDI over time, despite the disease's increased incidence. However, patients with inflammatory bowel disease were 11.4 times as likely to have CDI compared with childlren without this condition. Solid-organ transplants, HIV infection, and transplantation of blood-forming stem cells—all requiring or resulting in immune suppression—increased the odds of CDI 3.3- to 4.5-fold in adjusted multivariable analysis.
The researchers used data from the AHRQ-funded Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) for 1997, 2000, 2003, and 2006. HCUP-KID is a stratified random sample of 5.8 million inpatient discharges for children from 22 to 38 States (depending on the year). For 2006, it represented an estimated 89 percent of all pediatric hospital discharges in the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS016957).
More details are in "Clostridium difficile infection in hospitalized children in the United States," by Cade M. Nylund, M.D., Anthony Goudie, Ph.D., Jose M. Garza, M.D., and others in the May 2011 Archives of Pediatrics and Adolescent Medicine 165(5), pp. 451-457.