Clostridium difficile Infection is associated with Increased Risk of Death and Prolonged Hospitalization in Children.
Clin Infect Dis. 2013 Mar 26;
Authors: Sammons JS, Localio R, Xiao R, Coffin SE, Zaoutis T
Background. C. difficile infection (CDI) is associated with significant morbidity and mortality among adults. Although CDI has increased among children, outcomes are poorly defined. Methods. A retrospective cohort study was performed among hospitalized children aged 1-18 years at 41 free-standing children's hospitals between 1/2006 and 8/2011. Patients with CDI (exposed) were matched 1:2 to patients without CDI (unexposed) based on the probability of developing CDI (propensity score derived from patient characteristics). Studied outcomes included death, length of stay (LOS), and total standardized cost. Sub-analyses were performed after stratifying exposed subjects by C. difficile test date, suggestive of community-onset (CO) versus hospital-onset (HO)-CDI. Results. We identified 5,107 exposed and 693,409 unexposed subjects. Age in years was 6 (2, 13) for exposed and 8 (3, 14) for unexposed [median (IQR)]. Of these, 4,474 exposed were successfully matched to 8,821 unexposed by propensity score. In-hospital mortality differed significantly [CDI (1.43%), matched unexposed (0.66%); (p<0.001)]. On sub-analysis, mortality rates were similar between CO-CDI and matched unexposed subjects. However, mortality rates were significantly greater among HO-CDI compared with matched unexposed [6.73 (3.77, 12.02); OR (95% CI)]. Mean differences in LOS and cost were significant [mean difference (95% CI)]: 5.55 days (4.54, 6.56) and $18, 900 (15,100, 22,700) for CO-CDI, and 21.60 days (19.29, 23.90) and $93, 600 (80,000, 107,200) for HO-CDI. Conclusions. Pediatric CDI is associated with increased mortality, longer LOS, and higher costs among hospitalized children. These findings underscore the importance of antibiotic stewardship and infection control programs to prevent this disease in children.
PMID: 23532470 [PubMed - as supplied by publisher]