Clostridium difficile Infection in Pediatric Solid Organ Transplant Recipients: Presidential Poster

Abstract

Introduction: The incidence of Clostridium difficile infection (CDI) is increasing in the pediatric population. Pediatric recipients of solid organ transplantation (SOT) may be at a higher risk for CDI in part due to chemotherapy and prolonged hospitalization. Methods: We utilized data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) to study the incidence and outcomes related to CDI as a complicating factor in pediatric recipients of SOT. Results: In 2012 there were an estimated total of 1,580,200 U.S. hospital discharges for children 1-17 years of age. Of these, 12,797 patients had an ICD-9-CM code that identified their hospital stay with a diagnosis relating to one or more of the 6 organ transplants assessed in this study, which were liver, kidney, lung, heart, intestinal and pancreas. In a contemporaneous time period and age group, there were a total of 9,180 hospital discharges with a diagnosis of CDI. The highest incidence was in children with pancreas (7.7%) and intestinal (5.2%) transplantation while the lowest incidence was in children with renal transplantation (2.3%). The rate of CDI infection in children without SOT was 0.6% and was substantially greater (3.6%) in children with SOT (OR 6.6; 95% CI 6.0-7.3; p < 0.05). The rate of CMV infection was higher in the SOT+CDI group compared to children in the SOT-only group (3.7% versus 1.9%; p < 0.05). Similarly, the incidence of GVHD was also higher in SOT patients with CDI (1.50% versus 0.6%; p < 0.05). However, the rate of PTLD, which was approximately 4.0%, did not differ between the two groups (p=0.87). The greatest risk of CDI infection was noted for younger children with additional comorbidities and severe illness. The presence of CDI as a complicating factor in SOT was not independently associated with a higher risk of mortality (aOR 1.5; 95% CI 0.6-4.0). However, CDI did result in a greater-than-median length of stay (aOR 1.7; 95% CI 1.3-2.2) and higher-than-median hospitalization charges (aOR 1.3; 95% CI 1.1-1.7). Conclusion: To our knowledge, this is the first pediatric study utilizing multi-institutional national data to examine the relationship of CDI as a complicating factor in SOT patients. The occurrence of CDI in the pediatric SOT population contributes to a greater length of stay and higher hospital charges. However CDI is not an independent predictor of increased in hospital mortality in these patients.Figure 1Figure 2