Abstract
BackgroundClostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. The aim of this study was to determine the incidence and potential risk factors for C. difficile infection (CDI) in hospitalized children who developed diarrhea. A retrospective study was performed at a university hospital in İstanbul over a three-year period (2012–2014).ResultsDuring the study period 12,196 children were hospitalized, among them 986 (8 %) children with diarrhea were investigated for CDI and 100 (0.8 %) children were diagnosed with CDI. The incidence of CDI in hospitalized children was 4/1000, 9/1000 and 9/1000 patients per year in year 2012, 2013 and 2014, respectively (p = 0.008, p < 0.01). The mean age of children with CDI (2.6 ± 2.6 months) was lower than children without CDI (57.5 ± 63.5 months) [p = 0.001]. In the multivariate analysis, the presence of underlying chronic diseases [presence of malnutrition (OR 7, 95 % CI 1.33–36.7, p = 0.021), presence of solid organ tumors (OR 6, 95 % CI 2.4–15.7, p < 0.00), presence of congenital heart diseases (OR 4.6, 95 % CI 1.13–18.7, p = 0.03), hospitalization in PICU (OR 15.6, 95 % CI 3.2–75.8, p = 0.001) and hospitalization in hematology and oncology ward (OR 7.8, 95 % CI 2–29.9, p = 0.002)] were found to be independent risk factors for CDI.ConclusionThis is the first description of the incidence and associated risk factors of CDI in Turkish children. One of the most important risk factor was prior antibiotic exposure which emphasizes the importance of antibiotic stewardship programs.
Highlights
Clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections
We retrospectively reviewed the medical records and ICD codes of pediatric patients aged between 0 months and 18 years who had the diagnosis of diarrhea and ICD (International Classification of Diseases) code for C. difficile between January 2012 and December 2014
Among them 986 (8 %) children who developed diarrhea 48 h after hospitalization were investigated for C. difficile infection (CDI)
Summary
Clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. The aim of this study was to determine the incidence and potential risk factors for C. difficile infection (CDI) in hospitalized children who developed diarrhea. Clostridium difficile is an anaerobic Gram positive, toxinproducing and spore forming bacillus that can cause a range of illnesses from antibiotic-associated mild diarrhea to fulminant diseases such as pseudomembranous colitis, sepsis and death (Nylund et al 2011). C. difficile spores are resistant to heat, disinfectants and antibiotics and they can survive in hospital environment for several months. Contaminated medical devices lead to Clostridium difficile is one of the most common healthcare-associated infections and it is responsible for 15–25 % of cases of nosocomial antibiotic-associated diarrhea (Lessa et al 2015; Bartlett 2002). It causes diarrhea due to alteration of colonic flora, which is generally caused by antibiotic therapy and ingestion of the microorganism leading to toxin production followed by mucosal injury
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