Study Finds Increasing Trend in CDI Among Hospitalized Children

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WASHINGTON, DC—Hospitalized children in the US are becoming infected with the bacteria Clostridium difficile (CDI) more frequently, according to researchers from the Uniformed Services University of the Health Sciences (USU) and Cincinnati Children’s Hospital Medical Center.

The findings of the research will appear in the May issue of Archives of Pediatrics & Adolescent Medicine, and were also made available online last month.

Clostridium difficile infections can cause diarrhea and more serious intestinal conditions, including colitis. Known factors for the development of these infections include antibiotics, acid suppression medication, and chemotherapy.

The researchers studied data on nearly 10.5 million children discharged from US hospitals in 1997, 2000, 2003, and 2006. Their objective was to evaluate the trend of these infections among hospitalized children in the US and to evaluate the severity of and risk factors associated with these cases of CDI.

Of the data on nearly 10.5 million children studied, 21,274 were diagnosed with CDI. There was an increasing trend of CDI, from 3,565 cases in 1997 to 7,779 cases in 2006 – an average increase of 14.9% each year.

The researchers also found that children with CDIs had a greater likelihood of death, higher incidence of colectomies, longer hospital stays, and overall higher hospitalization expenses than those without CDI. “There has been a large and significant increase in the national rate of C difficile infections in hospitalized children, a nearly 15% increase each year,” says Mitch Cohen, MD, director of the division of Gastroenterology, Hepatology and Nutrition at Cincinnati Children’s Hospital and the study’s senior author.

Inflammatory bowel disease (IBD) was the most highly associated comorbid diagnosis with CDI and children with IBD were 11 times more likely to have a diagnoses of CDI than children without IBD in the study.

The authors also found the risk of infection was higher among those who were white, lived in the west or in urban areas, or had private insurance. “We don’t know exactly why we see these populations [having] an increased risk,” said study lead author Air Force Maj Cade Nylund, MD, an assistant professor of pediatrics at the USU. “However, it likely has much to do with antibiotic exposure, which is a major risk factor for development of C difficile.”

The authors concluded that the study supports previous reports that CDI is increasing among hospitalized children and “provides a background for understanding changing trends and risk factors of CDI in children … Increasing awareness of these risk factors and of an upward trend in hospitalized children with CDI is the first step in controlling this important infection.”

Nylund performed this research during his fellowship in pediatric gastroenterology at Cincinnati Children’s Hospital in collaboration with Drs Anthony Goudie, Jose Garza, Gerry Fairbrother, and Mitchell Cohen.

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