More Hospitalized Children Infected with Clostridium Difficile
Earlier this year, a government quality report found that there has been “very little progress” on eliminating hospital-acquired infections despite years of prevention campaigns. A new study on hospitalized pediatric patients also shows a disturbing infection trend. The prevalence of Clostridium difficile infection (CDI) appears to be increasing in this population in the United States.
C. Diff Affects About 1 in 100 Hospitalized Patients
Clostridium difficile (C.diff) is a bacteria that colonizes the gastrointestinal tract and can lead to infections with symptoms that include diarrhea, extreme inflammation and distention of the large intestine (toxic megacolon), and perforated bowel.
CDI has been considered a disease that occurs primarily in hospitals affecting more than 1 in 100 hospital patients, but there are reports of the condition becoming more common in the general population, the authors of the new study write in the Archives of Pediatric and Adolescent Medicine.
Cade M. Nylund MD of the Department of Pediatrics at Uniformed Services University of the Health Sciences in Bethesda, Maryland writes, “In recent years, there have been 2 studies showing an increasing CDI trend in children.”
Using data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database for 1997, 2000, 2003, and 2006, Dr. Nylund and colleagues learned that of over 10 million children hospitalized in those years, 21,274 (0.2%) had a discharge diagnosis of CDI. The number of cases trended upward and in 2006 there were 18% more children infected than in 1997.
Diagnoses associated with increased risk for Clostridium difficile infection include inflammatory bowel disease, immunosuppression, and antibiotic administration. Longer hospitalization stays also increased risk.
Overall, children with CDI were 1.2 times more likely to die while hospitalized than those with other conditions. They were also 4.3 times more likely to have a longer hospital stay, and about 1.4 times more likely to require intestinal surgery.
Nylund suspects that the rise in cases is due to the emergence of a more virulent strain of the bacteria – a “superbug” that is resistant to medications. An increase in antibiotic prescription may also play a role because these wipe out the “good” bacteria in the colon which modulate the growth of “bad” bacteria.
"Our 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," the study authors conclude. "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."
Arch Pediatr Adolesc Med. Published online January 3, 2011