ABSTRACT
BACKGROUND: The incidence and severity of Clostridium difficile infection (CDI) is increasing among adults; however, little is known about the epidemiology of CDI among children. METHODS: We conducted a nested case-control study to identify the risk factors for and a prospective cohort study to determine the outcomes associated with severe CDI at 2 children's hospitals. Severe CDI was defined as CDI and at least 1 complication or ≥2 laboratory or clinical indicators consistent with severe disease. Studied outcomes included relapse, treatment failure, and CDI-related complications. Isolates were tested to determine North American pulsed-field gel electrophoresis type 1 lineage. RESULTS: We analyzed 82 patients with CDI, of whom 48 had severe disease. Median age in years was 5.93 (1.78-12.16) and 1.83 (0.67-8.1) in subjects with severe and nonsevere CDI, respectively (P = 0.012). All patients with malignancy and CDI had severe disease. Nine subjects (11%) had North American pulsed-field gel electrophoresis type 1 isolates. Risk factors for severe disease included age (adjusted odds ratio [95% confidence interval]: 1.12 [1.02, 1.24]) and receipt of 3 antibiotic classes in the 30 days before infection (3.95 [1.19, 13.11]). If infants less than 1 year of age were excluded, only receipt of 3 antibiotic classes remained significantly associated with severe disease. Neither the rate of relapse nor treatment failure differed significantly between patients with severe and nonsevere CDI. There was 1 death. CONCLUSIONS: Increasing age and exposure to multiple antibiotic classes were risk factors for severe CDI. Although most patients studied had severe disease, complications were infrequent. Relapse rates were similar to those reported in adults.
Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Clostridium Infections/microbiology , Case-Control Studies , Child , Child, Preschool , Clostridioides difficile/classification , Clostridioides difficile/genetics , Clostridium Infections/mortality , Clostridium Infections/pathology , Cohort Studies , Electrophoresis, Gel, Pulsed-Field , Female , Genotype , Hospitals, Pediatric , Humans , Infant , Male , Molecular Typing , Prospective Studies , Recurrence , Risk Factors , Treatment FailureABSTRACT
We sought to determine the frequency of horizontal transmission of antibiotic-resistant gram-negative bacilli (ARGNB) in a pediatric intensive care unit during a nonoutbreak period. Among 5,300 admissions over 39 consecutive months, 13 ARGNB clusters involving 35 children were identified by pulsed-filed gel electrophoresis analysis, which suggests that person-to-person transmission was uncommon.
Subject(s)
Cross Infection/transmission , Enterobacteriaceae , Gram-Negative Bacterial Infections/transmission , Intensive Care Units, Pediatric , Pseudomonas aeruginosa , Stenotrophomonas maltophilia , Adolescent , Adult , Child , Child, Preschool , Drug Resistance, Multiple, Bacterial , Electrophoresis, Gel, Pulsed-Field , Enterobacteriaceae/genetics , Enterobacteriaceae Infections/transmission , Female , Humans , Infant , Male , Pseudomonas Infections/transmission , Pseudomonas aeruginosa/genetics , Stenotrophomonas maltophilia/genetics , Young AdultABSTRACT
A hypervirulent strain of Clostridium difficile-labeled North American Pulsed Field type 1 causes severe disease in adults. To determine the prevalence of NAP1 C. difficile in children, organisms from consecutive C. difficile toxin-positive stool samples at 2 children's hospitals microbiology laboratories were characterized. We found that 19.4% of these samples were NAP1.
