Risk Factors for Community-Associated Clostridium difficile

Abstract

Research Article| October 01 2017 Risk Factors for Community-Associated Clostridium difficile AAP Grand Rounds (2017) 38 (4): 43. https://doi.org/10.1542/gr.38-4-43 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Risk Factors for Community-Associated Clostridium difficile. AAP Grand Rounds October 2017; 38 (4): 43. https://doi.org/10.1542/gr.38-4-43 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: clostridium difficile, community, outpatients, exposure, cephalosporins, clindamycin, fluoroquinolones Source: Adams DJ, Eberly MD, Rajnik M, et al. Risk factors for community-associated Clostridium difficile infection in children. J Pediatr. 2017; 186: 105– 109; doi: https://doi.org/10.1016/j.jpeds.2017.03.032Google Scholar Investigators from the Naval Medical Center in Virginia and Uniformed Services University in Maryland conducted a cross-sectional analysis to identify risk factors associated with community-associated Clostridium difficile infection (CDI). Investigators identified cases by using billing records from the TRICARE Management Activity Military Health System database, which includes all eligible military dependents cared for in both military and civilian facilities. Cases were defined as children aged 1–18 years old who received care from 2001 to 2013 and had an ICD-9 diagnostic code for CDI. Any child hospitalized prior to the diagnosis of CDI was excluded. Cases were matched by age and sex to 3 control subjects who did not have an ICD-9 diagnostic code for CDI. The primary exposure was medications prescribed in the 12 weeks preceding the date of the first CDI, as determined by using outpatient pharmacy records. Medications were grouped into oral antibiotics (clindamycin; fluoroquinolones; sulfonamides; macro-lides; penicillins; amoxicillin and clavulanate; tetracyclines; and first-, second-, and third-generation cephalosporins), gastric-acid suppression medications (proton pump inhibitors, H2-receptor antagonists), and corticosteroids. Secondary exposures included visits to outpatient health care settings, siblings <1 year of age, and family members with a CDI diagnosis. The investigators used logistic regression to determine the odds of CDI according to each exposure after adjusting for potential confounders. There were 1,331 cases and 3,993 control subjects included in the analysis. Among the cases, 59.7% had exposure to ≥1 antibiotic. When compared to control subjects, the antibiotic exposures most associated with CDI were fluoroquinolones (4% in cases vs 0% in control subjects), clindamycin (8% in cases vs <1% in control subjects; adjusted odds ratio [aOR], 73; 95% confidence interval [CI], 13.8–384.7), and third-generation cephalosporins (16% in cases vs 1% in control subjects; aOR, 16.3; 95% CI, 9.1–29.3). The odds of CDI also increased with the number of antibiotic class exposures, from an aOR of 6.1 with exposure to 1 class of antibiotic, an aOR of 22.1 with exposure to 2 classes of antibiotics, and an aOR of 38.5 with exposure to ≥3 antibiotic classes. Other medications significantly associated with CDI included proton-pump inhibitors (aOR, 8.2) and H2-receptor antagonists (aOR, 3.3). Outpatient health care clinic visits were also significantly associated with CDI (aOR, 1.35), as were family members with a CDI diagnosis. The investigators conclude that CDI is associated with a number of commonly prescribed medications in the outpatient setting. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. CDI, the most common cause of health care–associated diarrhea in the United States, is increasingly recognized in community settings (AAP Grand Rounds, March 2014;31[3]:30).1 In the current study, each additional outpatient clinic visit increased the odds of children developing... You do not currently have access to this content.