Clostridium difficile Infection in a Pediatric Population

Abstract

Background: The risks for chronic gastrointestinal illness (GI) when relocated short-term to other countries and when taking antibiotic prophylaxis in areas where malaria is endemic are unknown. A cluster of Australian Federal Police officers returning from overseas duty reported acute and chronic GI illnesses and some were diagnosed with inflammatory bowel disease. Aims: To examine the associations of deployment to developed or developing countries and exposure to doxycycline with the new onset of acute GI illness, functional bowel disorder (FBD) and inflammatory bowel disease (IBD). Methods: A cross-sectional web-based survey of all current and past members of the Australian Federal Police Association was undertaken. Independent predictors of gastrointestinal illness were examined by logistic regression analysis relative to those not deployed without exposure to doxycycline. Results: Of 1300 respondents (response rate 34%), 133 were excluded due to pre-existing chronic GI illness. Median age range was 36 to 45 years old with male predominance. 590 had episodes of overseas deployment for a median duration of 6.5 (range 0.1-149) months. 18 (3%) of those not deployed took doxycycline compared with 171 (30%) of those deployed. Those deployed abroad vs those not deployed reported gastroenteritis in 9.7% vs 0.7% (P<0.001), FBD in 4.7% vs 2.3% (P<0.001) and IBD 1.7% vs 1.4% (p=ns). Results of the multivariate analyses are shown in the table below. Conclusions: Being deployed abroad rather than doxycycline exposure is a risk factor for acute GI illness. The use of doxycycline in those deployed overseas is associated with the onset of FBD and possibly IBD. Doxycycline as a risk factor for chronic gastrointestinal illness warrants a prospective larger scale study.