Clostridium difficile Infections among Hospitalized Children, United States, 1997–2006

EID Journal Home > Volume 16, Number 4–April 2010

Volume 16, Number 4–April 2010
Research
Clostridium difficile Infections among Hospitalized Children, United States, 1997–2006
Marya D. Zilberberg, Glenn S. Tillotson, and L. Clifford McDonald
Author affiliations: University of Massachusetts, Amherst, Massachusetts, USA (M.D. Zilberberg); EviMed Research Group, LLC, Goshen, Massachusetts, USA (M.D. Zilberberg); ViroPharma Inc., Exton, Pennsylvania, USA (G.S. Tillotson); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L.C. McDonald)

Suggested citation for this article

Abstract
We evaluated the annual rate (cases/10,000 hospitalizations) of pediatric hospitalizations with Clostridium difficile infection (CDI; International Classification of Diseases, 9th revision, clinical modification code 008.45) in the United States. We performed a time-series analysis of data from the Kids' Inpatient Database within the Health Care Cost and Utilization Project during 1997–2006 and a cross-sectional analysis within the National Hospital Discharge Survey during 2006. The rate of pediatric CDI-related hospitalizations increased from 7.24 to 12.80 from 1997 through 2006; the lowest rate was for children <1 year of age. Although incidence was lowest for newborns (0.5), incidence for children <1 year of age who were not newborns (32.01) was similar to that for children 5–9 years of age (35.27), which in turn was second only to incidence for children 1–4 years of age (44.87). Pediatric CDI-related hospitalizations are increasing. A better understanding of the epidemiology and outcomes of CDI is urgently needed.

The epidemiology of Clostridium difficile infection (CDI) has been shifting over the past decade. Since 2000, the molecular evolution of the hypervirulent toxigenic bacterial strain BI/NAP1/027, which causes severe disease in massive outbreak settings, has been well documented (1–4). Furthermore, the increasing detection of this strain in the United States and other countries coincides with reports of increasing hospitalizations either resulting from or complicated by CDI and associated with increased case-fatality rates (5–7). Although in the past it was not thought to affect pediatric populations substantially, CDI has more recently been implicated as an increasingly prevalent diarrheal pathogen in children (8–10). Moreover, evidence suggests that a large proportion of pediatric CDI cases are community-acquired infections and that many of these infections lack the traditional risk factor of exposure to antimicrobial drugs (11–13). These changes in the epidemiology of pediatric CDI, although not definitively caused by the BI/NAP1/027 strain, are likely related to this strain because at least 2 reports suggest a high prevalence (10%–38%) of this strain in pediatric CDI populations and a 4× increase in complication rates associated with this strain compared with other strains (14,15).

Current age-specific epidemiology of CDI among children remains poorly studied. Literature predating the emergence of the epidemic strain suggests that although up to 67% of all neonates (i.e., <1 month of age) become colonized with C. difficile in the perinatal period, they do not appear to be at risk for the development of CDI-associated symptoms (16). Conversely, children 1 month–2 years of age, although less likely to become colonized with this bacterium, are more likely to have attendant disease (16). Finally, children 3–18 years of age have been reported to have similar risk for CDI as that seen in adults (16). Because the epidemiology of CDI is changing rapidly in children and adults, we examined age-specific trends in CDI-related hospitalizations in the US population <18 years of age.

open here to see the full-text:
http://www.cdc.gov/eid/content/16/4/604.htm


Suggested Citation for this Article
Zilberberg MD, Tillotson GS, McDonald LC. Clostridium difficile infections among hospitalized children, United States, 1997–2006. Emerg Infect Dis [serial on the Internet]. 2010 Mar [date cited]. http://www.cdc.gov/EID/content/16/4/604.htm

DOI: 10.3201/eid1604.090680