June 2010: Volume 36, Number 6

C. Dificile on the Rise in Children

New research indicates that Clostridium difficile infection (CDI)-related hospitalizations increased dramatically in children between 1997 and 2006, from 7.24 to 12.80 per 10,000 hospitalizations, a crude 9% per year rise (Emerg Infect Dis; 2010;16:604–9). Most of the increase occurred between 2000 and 2006 and may be an indication that the hypervirulent strain B1/NAP1/027, which has been well-documented in adults, is spreading into the pediatric population. In addition to the surge in CDI-related hospitalizations, the authors also found an increase in hospitalizations either resulting from or complicated by rotavirus infection.

The researchers based their analysis on two large databases, including the Kids’ Inpatient Database within the Healthcare Cost and Utilization Project administered by the Agency for Healthcare Research and Quality, which includes data from 3,789 hospitals and 38 states, and the National Hospital Discharge Survey, which is collected by the Centers for Disease Control and Prevention and covers approximately 500 hospitals. The combined analysis is more broadly representative of all pediatric admissions than other research on this topic and is generalizable to most U.S.-based institutions that care for children.

Children between 1–4 years were the most likely pediatric subgroup to have a CDI-related hospitalization, with a rate in 2006 of 44.87 per 10,000 hospitalizations, followed by children 5–9 years, with a rate of 35.27 per 10,000 hospitalizations, and non-newborn infants <1 year old with a rate of 32.01 per 10,000 hospitalizations. The role of C. difficile in the pathogenesis of disease in the latter group “remains perplexing,” according to authors. They were unable to determine whether the relatively high rate of CDI-related hospitalizations in this population predominantly represented true disease or colonization, which is known to be high in neonates. The low incidence of CDI-related hospitalizations in neonates reflects current recommendations against routine testing in this population. However, the higher incidence rate among babies <1 year old “indicates an urgent need for studies to determine how often C. difficile causes true disease in this population.”