S0193 Outcomes of Pediatric Hospital and Community-Associated Clostridioides difficile Infection

Abstract

INTRODUCTION: Incidence of Clostridioides difficile infection (CDI) in pediatric population is increasing, with paucity of data on CDI outcomes in this population, particularly in community-associated cases. METHODS: A population-based cohort study of the pediatric age group (< 18 years) from 2006 to 2017 was conducted using the Rochester Epidemiology Project. CDI was diagnosed with watery diarrhea and a positive stool assay, after exclusion of other causes of diarrhea. CDI was defined as healthcare-associated (HA) if symptoms occurred >48 hours after admission to or < =4 weeks of hospital discharge; community-acquired (CA) if there was no discharge from a hospital in the past 12 weeks; rest were indeterminate. CDI was considered severe if WBC ≥15000/µL or creatinine ≥1.5mg/dL, fulminant if there was ileus, megacolon, ICU admission, colectomy, hypotension or sepsis. Recurrence was defined with recurrent diarrhea within 8 weeks of the last episode, with positive stool assay and interim symptom resolution. Chi-square/Fischer’s exact tests were used for comparison of baseline characteristics and outcomes. P < 0.05 was considered statistically significant. RESULTS: From 2006 to 2017, 157 pediatric patients were identified with median age 3.6 years (range, 0.2–17.9), 54% (85) were female. Overall 12 patients with indeterminate CDI were excluded. Of the remaining patients, majority [67.6% (98)] had CA-CDI. Baseline characteristics of CA and HA CDI are outlined in Table 1; 48.3% (70) patients had antibiotic exposure, more in HA than CA CDI. Overall, 2.1% patients (3) had severe CDI, 9.6% (14) had fulminant CDI; 6.9% (10) required ICU admission. Overall, 8.3% (12) patients needed a change in treatment due to non-response or adverse events. Recurrence occurred in 20.1% (29) patients. Patients with CA-CDI were less likely to have fulminant disease and ICU admission compared to HA-CDI (Table 2). There were no CDI-related deaths. CONCLUSION: Community-acquired infection accounts for a majority of CDI in the pediatric age group, and is associated with better outcomes compared to healthcare-associated CDI.Table 1.: Baseline characteristics by mode of acquisition of CDI* *data presented as n (%) for categorical and median (min-max) for continuous variables) ^risk factor exposure within 90 days prior to CDI is reportedTable 2.: Outcome of CDI by mode of acquisition