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Changing Epidemiology of Clostridium difficile-Associated Disease in Children

Published online by Cambridge University Press:  02 January 2015

Lacey Benson ,
Xiaoyan Song ,
Joseph Campos  and
Nalini Singh
Lacey Benson
Affiliation:
Case Western School of Medicine, Cleveland Ohio
Xiaoyan Song
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Children's National Medical Center, Washington DC
Joseph Campos
Affiliation:
Department of Pediatrics, Washington DC Department of Pathology, Washington DC Department of Microbiology–Tropical Medicine, the Division of Laboratory Medicine, Washington DC Division of Infectious Diseases, George Washington University School of Medicine, Washington DC
Nalini Singh*
Affiliation:
Department of Pediatrics, Washington DC Children's National Medical Center, Washington DC Departments of Epidemiology and International Health, George Washington University School of Public Health, Washington DC
*
Epidemiology and International Health, theGeorge Washington University, Schools of Medicine and Public Health, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010 ([email protected])
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Abstract

Objective.

To determine temporal trends in the incidence rate for Clostridium difficile-associated disease (CDAD) in a pediatric patient population.

Methods.

We performed an observational, retrospective cohort study that included children who visited or were admitted to Children's National Medical Center during the period from July 2001 through June 2006. The CDAD incidence rates were determined and examined for changes over time using the Poisson regression method.

Results.

A total of 513 patients whose stool specimens tested positive for C. difficile toxin were identified. Of these patients, 61% were children aged 2 years or older. The proportion of patients with CDAD in this age group has steadily increased from 46% in 2001 to 64% in 2006. Largely as a result of an increasing number of cases of community-associated CDAD, the incidence of CDAD increased significantly in the outpatient setting, particularly in the emergency department (1.18 cases per 1,000 visits in 2001 vs 2.47 cases per 1,000 visits in 2006; P = .02). The incidence among inpatients decreased during the study period (1.024 cases per 1,000 patient-days in 2001 vs 0.680 cases per 1,000 patient-days in 2006; P = .004). In the neonatal intensive care unit, C. difficile toxin was detected in stool specimens collected from 22 patients aged from 15 days to 6 months.

Conclusion.

This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children—a population that has not been considered to be at high risk for this disease in the past—are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1233 - 1235
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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