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Clin Infect Dis. Distinguishing Community-Associated From Hospital-Associated Clostridium difficile Infections in Children: Implications for Public Health Surveillance
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
Distinguishing Community-Associated From Hospital-Associated Clostridium difficile Infections in Children: Implications for Public Health Surveillance
Sarah Tschudin-Sutter 1,3, Pranita D. Tamma 2, April N. Naegeli 1,a, Kathleen A. Speck 1, Aaron M. Milstone 2,3, and Trish M. Perl 1,3
Author Affiliations: <SUP>1</SUP>Department of Medicine, Division of Infectious Diseases <SUP>2</SUP>Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine <SUP>3</SUP>Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Correspondence: Trish M. Perl, MD, MSc, Department of Medicine, Division of Infectious Diseases, 327A Billings Bldg, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287 (tperl@jhmi.edu).
a Present affiliation: Global Health Outcomes, Eli Lilly and Company, Indianapolis, Indiana.
Abstract
Background.
Children are increasingly recognized as being at risk for C. difficile infection (CDI), even without prior exposure to antibiotics or the healthcare environment. We aimed to distinguish risk factors, clinical course, and outcomes between healthcare facility?associated (HA) and community-associated (CA) CDI.
Methods.
This was a retrospective, observational cohort study conducted at the Johns Hopkins Children's Center, Baltimore, Maryland. All inpatients, aged ≥1 year, hospitalized from July 2003 to July 2012 and diagnosed with CDI based on clinical characteristics and confirmatory laboratory testing were included. The main outcome was CDI, categorized as HA-CDI, CA-CDI, and ?indeterminate? (classified as disease onset in the community, 4?12 weeks from hospital discharge).
Results.
Two hundred two pediatric inpatients were diagnosed with CDI, of whom 38 had CA-CDI, 144 had HA-CDI, and 20 had indeterminate CDI. Children with indeterminate CDI had baseline characteristics similar to those identified for HA-CDI. Children hospitalized with CA-CDI were less likely to have comorbidities (odds ratio [OR], 0.14; 95% confidence interval [CI], .03?.65; P = .013), to have been exposed to antibiotics (OR, 0.17; 95% CI, .07?.44; P < .001), or prior surgeries (OR, 0.03; 95% CI, .00?.24; P = .001), compared to children with HA-CDI. Compared with HA-CDI, children with CA-CDI had a trend toward more episodes of septic shock (P = .07), toxic megacolon (P = .04), and recurrences (P = .04).
Conclusions.
In a hospitalized cohort, CA-CDI is more often seen in previously healthy children without antibiotic exposure or comorbid conditions and has more frequent complications and recurrences compared to HA-CDI. For surveillance purposes, ?indeterminate? CDI should be allocated to HA-CDI rather than CA-CDI.
Key words: community-associated C. difficile infection - hospital-associated C. difficile infection ? CDI ? children ? recurrence
Received March 30, 2013. Accepted July 26, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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Distinguishing Community-Associated From Hospital-Associated Clostridium difficile Infections in Children: Implications for Public Health Surveillance
Sarah Tschudin-Sutter 1,3, Pranita D. Tamma 2, April N. Naegeli 1,a, Kathleen A. Speck 1, Aaron M. Milstone 2,3, and Trish M. Perl 1,3
Author Affiliations: <SUP>1</SUP>Department of Medicine, Division of Infectious Diseases <SUP>2</SUP>Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine <SUP>3</SUP>Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Correspondence: Trish M. Perl, MD, MSc, Department of Medicine, Division of Infectious Diseases, 327A Billings Bldg, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287 (tperl@jhmi.edu).
a Present affiliation: Global Health Outcomes, Eli Lilly and Company, Indianapolis, Indiana.
Abstract
Background.
Children are increasingly recognized as being at risk for C. difficile infection (CDI), even without prior exposure to antibiotics or the healthcare environment. We aimed to distinguish risk factors, clinical course, and outcomes between healthcare facility?associated (HA) and community-associated (CA) CDI.
Methods.
This was a retrospective, observational cohort study conducted at the Johns Hopkins Children's Center, Baltimore, Maryland. All inpatients, aged ≥1 year, hospitalized from July 2003 to July 2012 and diagnosed with CDI based on clinical characteristics and confirmatory laboratory testing were included. The main outcome was CDI, categorized as HA-CDI, CA-CDI, and ?indeterminate? (classified as disease onset in the community, 4?12 weeks from hospital discharge).
Results.
Two hundred two pediatric inpatients were diagnosed with CDI, of whom 38 had CA-CDI, 144 had HA-CDI, and 20 had indeterminate CDI. Children with indeterminate CDI had baseline characteristics similar to those identified for HA-CDI. Children hospitalized with CA-CDI were less likely to have comorbidities (odds ratio [OR], 0.14; 95% confidence interval [CI], .03?.65; P = .013), to have been exposed to antibiotics (OR, 0.17; 95% CI, .07?.44; P < .001), or prior surgeries (OR, 0.03; 95% CI, .00?.24; P = .001), compared to children with HA-CDI. Compared with HA-CDI, children with CA-CDI had a trend toward more episodes of septic shock (P = .07), toxic megacolon (P = .04), and recurrences (P = .04).
Conclusions.
In a hospitalized cohort, CA-CDI is more often seen in previously healthy children without antibiotic exposure or comorbid conditions and has more frequent complications and recurrences compared to HA-CDI. For surveillance purposes, ?indeterminate? CDI should be allocated to HA-CDI rather than CA-CDI.
Key words: community-associated C. difficile infection - hospital-associated C. difficile infection ? CDI ? children ? recurrence
Received March 30, 2013. Accepted July 26, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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