Jim Kling

October 24, 2012

LAS VEGAS, Nevada — Clostridium difficile infection (CDI) in children leads to significantly worse hospital outcomes, including longer hospital stays and higher rates of colectomy, in-hospital mortality, and discharge to a short- or long-term care facility, according to a study presented here at the American College of Gastroenterology 2012 Annual Scientific Meeting and Postgraduate Course.

Previous studies in hospital and community populations have shown the CDI incidence to be increasing in both adults and children.

To examine epidemiology and outcomes in children in the United States, the researchers analyzed 2005 to 2009 data from the National Hospital Discharge Survey database. Data collected included patient demographics, diagnoses, procedures, and dismissal information. The researchers used International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes to identify CDI cases and comorbidities.

They conducted weighted analyses to determine incidence and to compare outcomes in children with and without CDI, after adjustment for age, sex, and comorbidities, including hematologic malignancies, solid tumors, and chronic lung disease. Hospital-admitted newborns were excluded.

The analysis involved 13.7 million inpatients over the 5-year study period (median age, 5 years; 47.8% female). The researchers estimated that there were 46,176 cases of CDI (0.34% of all pediatric admissions; median age, 3 years; 48.1% female). Throughout the study period, the annual CDI rate varied from 0.24% to 0.43%, but the researchers found no significant trend (P = .64).

Univariate analysis revealed that children with CDI had higher rates of adverse outcomes than children without CDI, including longer median hospital stays (6 vs 2 days), higher rates of colectomy (1.6% vs 0.32%; odds ratio [OR], 2.0; 95% confidence interval [CI], 1.7 to 2.4; P < .0001), higher all-cause in-hospital mortality (1.2% vs 0.48%; OR, 2.5; 95% CI, 2.3 to 2.7; P < .0001), and more discharges to a short- or long-term care facility (4.3% vs 2.7%; OR, 1.6; 95% CI, 1.5 to 1.7; P < .0001).

After adjustment for age, sex, and comorbidities, CDI was the strongest predictor of longer hospital stay (adjusted mean difference, 6.4 days; 95% CI, 5.4 to 7.4; P < 0.0001), higher rates of colectomy (OR, 2.1; 95% CI, 1.8 to 2.5; P < 0.0001), higher all-cause in-hospital mortality (OR, 2.3; 95% CI, 2.2 to 2.5; P < 0.0001), and more discharges to a short- or long-term care facility (OR, 1.7; 95% CI, 1.6 to 1.8; P < 0.0001).

"C difficile in children can lead to bad outcomes. Among children who have diarrhea, C difficile should be considered as a possibility, and these patients should be managed aggressively," Sahil Khanna, MD, assistant professor of medicine at the Mayo Clinic in Rochester, Minnesota, who presented the research, told Medscape Medical News. "We were hoping that the effect wouldn't be very significant, but it looks like that's not the case," he added.

It's not a huge problem, but 1.6% of children with CDI needed a colectomy," Mark Mellow, MD, medical director of INTEGRIS Digestive Health Center in Oklahoma City, Oklahoma, told Medscape Medical News.

Despite efforts to control C difficile, the lack of an overall trend in infection rate suggests that not much progress is being made. "I don't think we're making a huge dent in it. There's at least a leveling off of hospital-acquired cases, but it's not a dramatic drop, and in other areas it's increasing," Dr. Mellow noted.

Dr. Khanna and Dr. Mellow have disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2012 Annual Scientific Meeting and Postgraduate Course: Abstract 40. Presented October 23, 2012.