TY - JOUR
T1 - The epidemiology of clostridium difficile infection in children
T2 - A population-based study
AU - Khanna, Sahil
AU - Baddour, Larry M.
AU - Huskins, W. Charles
AU - Kammer, Patricia P.
AU - Faubion, William A.
AU - Zinsmeister, Alan R.
AU - Harmsen, W. Scott
AU - Pardi, Darrell S.
N1 - Funding Information:
Financial support. This work was supported by the Rochester Epidemiology Project (REP), which is supported by the National Institute on Aging of the National Institutes of Health (award number R01AG034676), and ViroPharma, which provided an unrestricted research grant for an investigator-initiated study to support data extraction, study coordinator time, and statistical analysis.
PY - 2013/5/15
Y1 - 2013/5/15
N2 - Background. The incidence of Clostridium difficile infection (CDI) is increasing, even in populations previously thought to be at low risk, including children. Most incidence studies have included only hospitalized patients and are thus potentially influenced by referral or hospitalization biases.Methods. We performed a population-based study of CDI in pediatric residents (aged 0-18 years) of Olmsted County, Minnesota, from 1991 through 2009 to assess the incidence, severity, treatment response, and outcomes of CDI.Results. We identified 92 patients with CDI, with a median age of 2.3 years (range, 1 month-17.6 years). The majority of cases (75%) were community-acquired. The overall age-and sex-adjusted CDI incidence was 13.8 per 100 000 persons, which increased 12.5-fold, from 2.6 (1991-1997) to 32.6 per 100 000 (2004-2009), over the study period (P <. 0001). The incidence of community-acquired CDI was 10.3 per 100 000 persons and increased 10.5-fold, from 2.2 (1991-1997) to 23.4 per 100 000 (2004-2009) (P <. 0001). Severe, severe-complicated, and recurrent CDI occurred in 9%, 3%, and 20% of patients, respectively. The initial treatment in 82% of patients was metronidazole, and 18% experienced treatment failure. In contrast, the initial treatment in 8% of patients was vancomycin and none of them failed therapy.Conclusions. In this population-based cohort, CDI incidence in children increased significantly from 1991 through 2009. Given that the majority of cases were community-acquired, estimates of the incidence of CDI that include only hospitalized children may significantly underestimate the burden of disease in children.
AB - Background. The incidence of Clostridium difficile infection (CDI) is increasing, even in populations previously thought to be at low risk, including children. Most incidence studies have included only hospitalized patients and are thus potentially influenced by referral or hospitalization biases.Methods. We performed a population-based study of CDI in pediatric residents (aged 0-18 years) of Olmsted County, Minnesota, from 1991 through 2009 to assess the incidence, severity, treatment response, and outcomes of CDI.Results. We identified 92 patients with CDI, with a median age of 2.3 years (range, 1 month-17.6 years). The majority of cases (75%) were community-acquired. The overall age-and sex-adjusted CDI incidence was 13.8 per 100 000 persons, which increased 12.5-fold, from 2.6 (1991-1997) to 32.6 per 100 000 (2004-2009), over the study period (P <. 0001). The incidence of community-acquired CDI was 10.3 per 100 000 persons and increased 10.5-fold, from 2.2 (1991-1997) to 23.4 per 100 000 (2004-2009) (P <. 0001). Severe, severe-complicated, and recurrent CDI occurred in 9%, 3%, and 20% of patients, respectively. The initial treatment in 82% of patients was metronidazole, and 18% experienced treatment failure. In contrast, the initial treatment in 8% of patients was vancomycin and none of them failed therapy.Conclusions. In this population-based cohort, CDI incidence in children increased significantly from 1991 through 2009. Given that the majority of cases were community-acquired, estimates of the incidence of CDI that include only hospitalized children may significantly underestimate the burden of disease in children.
KW - Clostridium difficile infection
KW - community-acquired
KW - epidemiology
KW - pediatric
KW - population-based
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U2 - 10.1093/cid/cit075
DO - 10.1093/cid/cit075
M3 - Article
C2 - 23408679
AN - SCOPUS:84877309639
SN - 1058-4838
VL - 56
SP - 1401
EP - 1406
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -