Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1266-1270 (doi:10.1542/10.1542/peds.2008-0469)

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ARTICLE

Epidemiological Features of Clostridium difficile-Associated Disease Among Inpatients at Children's Hospitals in the United States, 2001–2006

Jason Kim, MD^a,b, Sarah A. Smathers, MPH^a, Priya Prasad, MPH^a, Kateri H. Leckerman, MS^a, Susan Coffin, MD, MPH^a,b,c and Theoklis Zaoutis, MD, MSCE^a,b,c,d

^a Division of Infectious Diseases
^b Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^c Departments of Pediatrics
^d Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

OBJECTIVE. Clostridium difficile is the main cause of nosocomial and antibiotic-associated diarrhea in adults. Recently, the incidence and severity of C difficile-associated disease in adults have been increasing. Whether similar phenomena are occurring among children remains unknown. Our study describes the epidemiological features of C difficile-associated disease in hospitalized children.

METHODS. We conducted a retrospective cohort study of hospitalized children with C difficile-associated disease at 22 freestanding children's hospitals in the United States, from 2001 to 2006. Cases of C difficile-associated disease were defined as a hospitalized child with a discharge code for C difficile infection, a laboratory billing charge for a C difficile toxin assay, and receipt of antimicrobial therapy for C difficile-associated disease.

RESULTS. We identified 4895 patients with C difficile-associated disease. Over the study period, the annual incidence of C difficile-associated disease increased from 2.6 to 4.0 cases per 1000 admissions and from 4.4 to 6.5 cases per 10 000 patient-days. The median age of children with C difficile-associated disease was 4 years. Twenty-six percent of patients were <1 year of age. The majority of patients (67%) had underlying chronic medical conditions. The colectomy and all-cause mortality rates among children with C difficile-associated disease did not increase during the study period.

CONCLUSIONS. The annual incidence of C difficile-associated disease in hospitalized children increased significantly from 2001 to 2006. However, the rates of colectomy and in-hospital death have not increased in children with C difficile-associated disease as they have among adults. The risk factors and outcomes for children with C difficile-associated disease remain to be defined in future studies.

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Key Words: Clostridium difficile • diarrhea • epidemiology • pediatric

Abbreviations: CDAD—Clostridium difficile-associated disease • PHIS—Pediatric Health Information System • IQR—interquartile range • NAP1—North American pulsed-field gel electrophoresis type 1

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Accepted Mar 13, 2008.

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