Su1066 Rising Incidence of Clostridium difficile Infection in Children; Results From the Hcup-Kid 2003 - 2012

Abstract

Background Clostridium difficile (C. difficile) infection (CDI) in children is an increasing problem in the United States. .Recent studies in adult patients indicate that the incidence of CDI in the U.S. continues to increase. However, contemporary data regarding the incidence of this disease in children have not been reported. Aim To describe the most current temporal trends for pediatric CDI both in an overall context as well as a complicating factor in other medical disorders. Methods: We obtained data for this study from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID), sponsored by the Agency for Healthcare Research and Quality. We used the ICD-9-CM diagnostic code for CDI (00845) to identify cases. Children less than 1 year of age were excluded. We evaluated CDI incidence in seven disease states, using ICD-9 diagnostic codes. The were inflammatory bowel disease (IBD), solid organ transplant (SOT), human immunodeficiency virus (HIV) infection, hematopoietic stem cell transplantation (HSCT), neoplastic disease, fungal infection, cystic fibrosis (CF) and pancreatitis. For trend analysis we utilized the Cochrane-Armitage test. Results From 2003 to 2012 there was a significant increasing trend in the incidence of CDI in hospitalized children; both overall and in each defined age group. The incidence increased 145% from 24.0 to 58.0 CDI discharges per 10,000 discharges per year (p < 0.001). Increases in incidence of 120% to 181% were observed for each age group (p < 0.001) with the greatest increase for children aged 15 years and above. The 1 4 year age group demonstrated the highest incidence of CDI during each triennial study period (p < 0.001). We also observed an increased incidence of CDI from 2003 2012 in each of the seven disease conditions studied. The greatest incidence of CDI was noted for HSCT and IBD (5.7 cases of CDI per 100 discharges). While the rate of CDI infection increased significantly in all of these medical diseases, the greatest rate of increase was observed in children who had undergone SOT (140% from 2003 2012; p < 0.001). Conclusion Our study demonstrates an increase in the incidence of CDI in hospitalized children within the U.S. from 2003 -2012. The increased incidence of disease occurred in all pediatric age groups and in several disease conditions known to be strongly associated with CDI. Considering the significant increase in CDI incidence, the effectiveness of hospital control programs and antibiotic stewardship in the prevention of pediatric CDI should be assessed.