- Article
Clostridium difficile Infection Among Children Across Diverse US Geographic Locations
- Joyanna M. Wendt, MD, MPHa,b,
- Jessica A. Cohen, MPHa,c,
- Yi Mu, PhDa,
- Ghinwa K. Dumyati, MDd,
- John R. Dunn, DVM, PhDe,
- Stacy M. Holzbauer, DVM, MPHf,g,
- Lisa G. Winston, MDh,
- Helen L. Johnston, MPHi,
- James I. Meek, MPHj,
- Monica M. Farley, MDk,l,
- Lucy E. Wilson, MD, ScMm,
- Erin C. Phipps, DVM, MPHn,
- Zintars G. Beldavs, MSo,
- Dale N. Gerding, MDp,q,
- L. Clifford McDonald, MDa,
- Carolyn V. Gould, MD, MSCRa, and
- Fernanda C. Lessa, MD, MPHa
+Author Affiliations
ABSTRACT
OBJECTIVE: Little is known about the epidemiology of Clostridium difficileinfection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups.
METHODS: Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010–2011 were used to identify cases (ie, residents with C difficile–positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years.
RESULTS: Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100 000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks.
CONCLUSIONS: Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.
- Accepted January 3, 2014.
- Copyright © 2014 by the American Academy of Pediatrics
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