Rising numbers of C difficile infections have been a growing concern in hospitals, with the use of antibiotics such as fluoroquinolones being implicated in adult infections.However,dataabout risk factors associated with pediatric C difficile infections have been limited. ThomasJ.Sandora,MD,MPH,anepidemiologist and medical director of infection control at Children’s Hospital in Boston,andcolleaguesconductedanested case-control study at Children’s Hospital that compared 94 pediatric patients with diarrhea who tested positive for C difficile with 238 matched controls (patients with a negative test for C difficile, 2controlspercase)betweenJanuaryand August2008.Severalriskfactorswerecorrelatedwiththe infection, includinghaving received an organ transplant (odds ratio [OR], 8.09; 95% confidence interval [CI], 2.10-31.12), a lack of previous hospitalization(OR,8.43;95%CI,4.3916.20), and having a feeding tube (OR, 3.32;95%CI,1.71-6.42).Antibiotictreatment intheprevious4weekswasalsoassociated with C difficile infection; treatmentwith fluoroquinolonesconferreda higher risk (OR, 17.04; 95% CI 5.8649.54) than nonfluoroquinolones (OR, 2.23 95% CI, 1.18-4.20). Previousstudieshadsuggestedpatients withcompromisedimmunesystemsand thosetreatedwithantibioticswereatrisk. Sandora said ina telephone interviewafter the meeting that fluoroquinolones wereaknownriskfactorinadultsbecause treatment with these antibiotics can disturb intestinal floral in such a way that allowsCdifficiletoflourish.Feedingtubes also had been implicated previously as a riskfactorinadults; thecurrentstudywas the first to find such a link in children. Additionally, one-quarter of the cases Sandora and his colleagues identified were community-associated infections. Sandora explained that national statistics suggest community-acquired C difficile cases are increasing for reasons that are not entirely clear. In light of these findings, Sandora urged physicians to consider the possibility of C difficile in pediatric patients with risk factors, such as having been treated with antibiotics, being immunosuppressed, or having a feeding tube. “Physicians should consider C diff even in a child who has not been hospitalized,” he said.