Antibiotic Use Linked with Most C Difficile Infections in Kids

A new study finds that 73% of children who developed Clostridium difficile infection were prescribed antibiotics in the 12 weeks prior to diagnosis, and 71% of cases were community-associated.

Almost three-fourths of children diagnosed with Clostridium difficile infection (CDI) were prescribed antibiotics during the months leading up to their diagnosis, according to the results of a new study. The study, published online on March 3, 2014, in Pediatrics, also found that the majority of CDI cases among children were community-associated.

Using population-based CDI surveillance data gathered from 10 areas of the United States from 2010 to 2011, the researchers analyzed the incidence, characteristics, and outcomes of CDI among children aged 1 to 17 years. For each identified case of CDI, medical records were reviewed to determine whether the infection was related to hospitalization or whether it was community-associated and to assess medication exposure in the 2 weeks before stool collection. In a smaller sample of cases, researchers carried out telephone interviews with the affected children or their parents about the children’s CDI symptoms, medical history, and exposure to health care facilities and medications in the 12 weeks before stool collection. Data was analyzed and compared across age groups.

During the study period, 944 cases of CDI occurred among 885 children included in the sample. Infection incidence was highest among white children and among those aged 1 year. The number of CDI cases in patients aged 1 to 6 years decreased from 66.3 cases to 13.8 cases per 100,000 children and increased in those aged 14 to 17 from 8.8 cases to 25.6 cases per 100,000 children. However, the severity of infections did not differ significantly across age groups. Signs and symptoms of CDI were mild and similar across all ages, and only 8% of affected children developed severe cases. Overall, 71% of cases were community-associated, and more than 50% of cases within each age group were community-associated.

The results also indicated that many children diagnosed with CDI had been recently exposed to antibiotics. Overall, 33% of the affected children had received antibiotics during the 2 weeks before they tested positive for CDI, and this proportion did not significantly differ across age groups. Among the smaller group of patients who provided additional information through interviews, 73% reported antibiotic use during the 12 weeks before diarrhea onset. These antibiotics were most commonly used to treat ear, sinus, or upper respiratory tract infections.

The high incidence of CDI among infants aged 1 year may be related to the fact that children aged 2 years and younger have the highest outpatient antibiotic prescribing rate, the authors suggest. The prevalence of community-associated cases may also be related to antibiotic prescribing. Among community-associated cases, 87% reported exposure to outpatient health care facilities before infection, which could indicate that the children contracted the infection while at the facilities or that they were prescribed antibiotics during their visits to the facilities, the authors add.

“Exposure to antibiotics is the most important modifiable risk factor for CDI,” the authors write. “The findings from our study underscore the opportunity for effective antibiotic stewardship programs in pediatric outpatient settings to affect CDI incidence.”