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http://dx.doi.org/10.14776/piv.2020.27.e24

Incidence and Characteristics of Clostridioides difficile Infection in Children  

Jeong, Heera (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Kang, Ji-Man (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Ahn, Jong Gyun (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Publication Information
Pediatric Infection and Vaccine / v.27, no.3, 2020 , pp. 158-170 More about this Journal
Abstract
Purpose: We evaluated the incidence and characteristics of Clostridioides difficile infection (CDI) in Korean children. Methods: Medical records of patients aged 2-18 years and diagnosed with CDI at a tertiary hospital between 2009 and 2018 were analyzed. The patients were classified into three CDI groups: community-acquired (CA), community onset-health care facility-associated (CO-HCFA), and healthcare facility onset (HO). Results: The incidence of CDI increased from 1.00 to 10.01 cases per 10,000 admissions from 2009 to 2018 (P<0.001). As compared to the CA group, the HO group had a higher frequency of operation and malignancy as predisposing factors (40.4% vs. 0.0%, P=0.001; and 27.7% vs. 0.0%, P=0.027, respectively), frequency and number of previous antibiotic use (97.9% vs. 31.3%, P<0.001; and 2 vs. 0, P<0.001, respectively), and median postdiagnosis hospital stay (13 vs. 5 days, P=0.008). The CO-HCFA group had a lower median age and higher frequency of malignancy than the CA group (5 vs. 13 years, P=0.012; and 30.8% vs. 0.0%, P=0.030, respectively). As compared to the HO group, the CA group had a higher frequency of abdominal pain and hematochezia (56.3% vs. 10.6%, P=0.001; and 50.0% vs. 10.6%, P=0.002, respectively), inflammatory bowel disease (68.8% vs. 2.1%, P=0.001), and intravenous metronidazole treatment (37.5% vs. 2.1%, P=0.001). Conclusions: With the increasing incidence of pediatric CDI, awareness regarding its epidemiology and clinical characteristics is important to manage nosocomial infections.
Keywords
Clostridioides difficile; Child; Epidemiology;
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1 Burke KE, Lamont JT. Clostridium difficile infection: a worldwide disease. Gut Liver 2014;8:1-6.   DOI
2 Gil JH, Seo JW. Clostridium difficile infections in children. Ewha Med J 2011;34:3-12.
3 Zhang S, Palazuelos-Munoz S, Balsells EM, Nair H, Chit A, Kyaw MH. Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study. BMC Infect Dis 2016;16:447.   DOI
4 Heister T, Wolkewitz M, Hehn P, Wolff J, Dettenkofer M, Grundmann H, et al. Costs of hospital-acquired Clostridium difficile infections: an analysis on the effect of time-dependent exposures using routine and surveillance data. Cost Eff Resour Alloc 2019;17:16.   DOI
5 Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825-34.   DOI
6 Lees EA, Miyajima F, Pirmohamed M, Carrol ED. The role of Clostridium difficile in the paediatric and neonatal gut - a narrative review. Eur J Clin Microbiol Infect Dis 2016;35:1047-57.   DOI
7 Enoch DA, Butler MJ, Pai S, Aliyu SH, Karas JA. Clostridium difficile in children: colonisation and disease. J Infect 2011;63:105-13.   DOI
8 Jangi S, Lamont JT. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutr 2010;51:2-7.   DOI
9 Stark PL, Lee A, Parsonage BD. Colonization of the large bowel by Clostridium difficile in healthy infants: quantitative study. Infect Immun 1982;35:895-9.   DOI
10 McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:987-94.   DOI
11 Pepin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466-72.   DOI
12 McFarland LV. Update on the changing epidemiology of Clostridium difficile-associated disease. Nat Clin Pract Gastroenterol Hepatol 2008;5:40-8.   DOI
13 Borali E, De Giacomo C. Clostridium difficile infection in children: a review. J Pediatr Gastroenterol Nutr 2016;63:e130-40.   DOI
14 Zilberberg MD, Tillotson GS, McDonald C. Clostridium difficile infections among hospitalized children, United States, 1997-2006. Emerg Infect Dis 2010;16:604-9.   DOI
15 Byun TJ, Han DS, Ahn SB, Cho HS, Kim TY, Eun CS, et al. Clinical characteristics and changing epidemiology of Clostridium difficile-associated disease (CDAD). Korean J Gastroenterol 2009;54:13-9.   DOI
16 Lee JH, Lee SY, Kim YS, Park SW, Park SW, Jo SY, et al. The incidence and clinical features of Clostridium difficile infection; single center study. Korean J Gastroenterol 2010;55:175-82.   DOI
17 Kim H, Lee Y, Moon HW, Lim CS, Lee K, Chong Y. Emergence of Clostridium difficile ribotype 027 in Korea. Korean J Lab Med 2011;31:191-6.
18 McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK, et al. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140-5.   DOI
19 Kim SJ, Kim H, Kim MS, Koh E, Kim CK, Jeong SH, et al. Evaluation of rapid assay (Tox A/B Quik Chek) for the detection of Clostridium difficile toxins A and B. Korean J Clin Microbiol 2008;11:112-6.   DOI
20 Song PH, Min JH, Kim YS, Jo SY, Kim EJ, Lee KJ, et al. Rapid and accurate diagnosis of Clostridium difficile infection by real-time polymerase chain reaction. Intest Res 2018;16:109-15.   DOI
21 Kim J, Smathers SA, Prasad P, Leckerman KH, Coffin S, Zaoutis T. Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001-2006. Pediatrics 2008;122:1266-70.   DOI
22 Kim B, Yang H, Jeong S, Lee K, Kim J, Ko J, et al. Clostridium difficile colitis in childhood: associated antibiotics. Korean J Pediatr Gastroenterol Nutr 2002;5:143-9.   DOI
23 Park JH, Kang KJ, Kang YN, Kim AS, Hwang JB. Pseudomembranous colitis in children: experience of a university hospital in Korea. Korean J Pediatr 2010;53:184-9.   DOI
24 Sandora TJ, Fung M, Flaherty K, Helsing L, Scanlon P, Potter-Bynoe G, et al. Epidemiology and risk factors for Clostridium difficile infection in children. Pediatr Infect Dis J 2011;30:580-4.   DOI
25 Centers for Disease Control and Prevention (CDC). Surveillance for community-associated Clostridium difficile--Connecticut, 2006. MMWR Morb Mortal Wkly Rep 2008;57:340-3.
26 Cho HJ, Ryoo E, Sun YH, Cho KH, Son DW, Tchah H. Epidemiology and clinical characteristics of Clostridium difficile-associated disease in children: comparison between community-and hospital-acquired infections. Korean J Pediatr Gastroenterol Nutr 2010;13:146-53.   DOI
27 Pascarella F, Martinelli M, Miele E, Del Pezzo M, Roscetto E, Staiano A. Impact of Clostridium difficile infection on pediatric inflammatory bowel disease. J Pediatr 2009;154:854-8.   DOI