S1218 A Population-Based Study: Prevalence of Clostridioides difficile Colitis in Pediatric Population With Known Sickle Cell Disease

Abstract

INTRODUCTION: Studies have shown that frequency of asymptomatic carriage of Clostridiodes difficile is higher among infants and children than adults. However, they are not likely to develop symptoms of infection unless they have other gastrointestinal disorders like inflammatory bowel disease. Pediatric patients with sickle cell disease (SCD) may be at higher risk of Clostridium difficile infection (CDI) due to multiple hospitalizations, antibiotic exposure and transfusions. To our knowledge, no large studies have evaluated the risk of CDI in pediatric population with known sickle cell disease. Our objective is to study the epidemiology of CDI associated with sickle cell disease in pediatric population. METHODS: We performed a retrospective population-based study using IBM EXPLORYS, a HIPPA-enabled web platform which includes over 65 million patient data, pooled from multiple healthcare systems that use electronic health records. Pediatric population <19 years with SCD which includes Hemoglobin SS, Hemoglobin SC and Sickle Beta-thalassemia and those without SCD were identified in the database and the prevalence of CDI in both the cohorts was evaluated. The prevalence was calculated per 100,000 population. Patient characteristics, comorbidities, transfusions, antibiotic exposure etc. were compared between the two cohorts. Chi-square with Yate’s correction was used for the comparison of different groups. Data were analyzed with R statistical software (RStudio, Inc. Boston, MA). RESULTS: A total of 11,917,280 pediatric patients were identified among which 29,440 (0.25%) had SCD diagnosis. The prevalence of CDI among the SCD pediatric patients was significantly higher than those without SCD (136 versus 44, P < 0.0001). The proportion of SCD patients with CDI who received red blood cell transfusions and immunosuppressant medication was significantly higher than those without SCD. Differences in other characteristics like gender and race were also noted. None of the SCD patients with CDI had IBD. There was no difference in the antibiotic exposure (Table 1). CONCLUSION: Pediatric SCD patients who are asymptomatic carriers may be at risk of HA-CDI due increased hospitalizations and transfusion need. Further prospective studies are needed to evaluate the risk of CDI in pediatric SCD population.Table 1.: Characteristics of Pediatric with Healthcare-Associated Clostridioides difficile Infection with and without Sickle cell disease