Epidemiologic surveillance of Clostridium difficile diarrhea in a freestanding pediatric hospital and a pediatric hospital at a university medical center

• Published in: Diagnostic microbiology and infectious disease Vol. 56; no. 2; pp. 109 - 114
• Main Authors: Rexach, Carmen E., Tang-Feldman, Yajarayma J., Cantrell, Mary C., Cohen, Stuart H.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2006; Elsevier
• Subjects: Biological and medical sciences; Carrier State; Child; Child, Preschool; Clostridium difficile; Clostridium difficile - isolation & purification; Diarrhea; Diarrhea - epidemiology; Diarrhea - microbiology; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - microbiology; Epidemiology; Feces - microbiology; Fundamental and applied biological sciences. Psychology; Hospitals; Humans; Infant; Infectious disease; Infectious diseases; Inpatients; Logistic Models; Medical sciences; Microbiology; Multivariate Analysis; Odds Ratio; Pediatrics; Population Surveillance; Diarrhea; Infectious disease; Pediatrics; Epidemiology; Clostridium difficile; Infection; Microbiology; Clostridiaceae; Clostridiales; Digestive diseases; Bacteria; Intestinal disease
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2006.03.002

To describe the epidemiology of Clostridium difficile in children, we cultured stool specimens from patients at the Children's Hospital Central California, Madera, CA (CHCC, n = 676) and at the University of California Davis Medical Center Pediatric Hospital, Sacramento, CA (UCDMC-PH, n = 301) for C. difficile, and toxins A and B genes and strain identity of the isolates were determined by polymerase chain reaction assays. A higher percentage of patients from UCDMC-PH were culture positive (148/301, 49%) and colonized with toxigenic strains (45/301, 15%) compared with CHCC (colonized = 178/676, 26%; toxigenic = 96/676, 14%, P ≤ .001). Multiple logistic regression analysis showed decreased colonization with inpatient status (odds ratio [OR] = 0.64; 95% confidence interval [CI] = 0.46, 0.89; P = .007) and use of H-2 antagonists (OR = 0.55; 95% CI = 0.36, 0.84; P = .006), whereas underlying conditions (colonization: OR = 1.42; 95% CI = 1.02, 1.96; P = .04; toxin positive: OR = 1.60; 95% CI = 1.04, 2.44; P = .03) and exposure to ≥2 antiinfectives (colonization: OR = 1.56; 95% CI = 1.10, 2.20; P = .01; toxin positive: OR = 1.71; 95% CI = 1.10, 2.66; P = .02) increased colonization. Most isolates appear to be community acquired, although molecular analysis suggests some nosocomial transmission at UCDMC-PH. These data suggest that the epidemiology of colonization with C. difficile in children is different than previously reported.