Canadian Pediatric C Difficile Rates Appear Stable

Pediatric cases of Clostridium difficile (C difficile) infection remained stable in 1 of Canada’s states (Manitoba), according to recent findings.

Investigators from the University of Manitoba in Canada collected 10 years’ worth of patient data in order to examine the trends in infection rates and the predictors of C difficile infection, which included recurrent cases in the pediatric population. The team used previously recommended definitions of rates and time trends in their determinations.

Infants can acquire C difficile infection in the first months of life, and symptoms can be as high as 73% by 6 months of age, as noted in a separate study. By age 2 and 3 years though, detection of C difficile drops rapidly and is detectable in 0%-3% of children—a similar rate to adults. By age 2 and 3 years though, detection of C difficile drops rapidly and is detectable in 0%-3% of children—a similar rate to adults.

However, the Manitoba investigators wrote that their investigation was prompted by the rise in childhood C difficile infection-related hospitalizations, which essentially doubled between 1997 and 2006.

Using the Manitoba Health Provider Claims as well as other population data sets, the investigators collected data from 2005 to 2015 on patients aged 2 to 17 years with C difficile infection. They confirmed the C difficile cases using the Manitoba Health Public Health Branch Epidemiology and Surveillance population-based laboratory-confirmed datasets. These patients were matched by age, sex, area of residence, and duration of Manitoba residency to patients without C difficile infection.

There were 193 incidents of C difficile infections from 162 children (about half were males) throughout the study period. Half were community acquired, and about 18.7% were health-care-facility-associated C difficile infection cases, while 15% were community onset, health-care-facility-associated C difficile infection cases.

The researchers followed children with and without C difficile infection for 828 and 2753 person-years, respectively, they reported. The overall C difficile infection rate during the study period was 7.8 cases per 100,000 person-years. There was not a significant change to the C difficile rate through the duration of the study period.

Some comorbid conditions were more prevalent in children with C difficile infection than their matched controls. These included Hirschsprung disease and inflammatory bowel disease.

The study authors also found that recurrent cases of C difficile infection were responsible for a tenth of C difficile infection episodes—as many as between 2-6 infections. Some of the predicting factors of recurrence were malignancy, diabetes, and neurodegenerative disease.

The team also found that community-acquired C difficile infection is responsible for a greater proportion of Canadian pediatric infection cases (51%) than had been previously reported.

“This finding may be related to ease of transmission and inconsistent adherence to proper hand hygiene and environmental cleaning and disinfection,” the study authors wrote. “Community implementation of antibiotic stewardship program may help in reducing community acquired C difficile infections.”

Recurrence was lower in this analysis (10%) than in other pediatric studies (which report between 4.5% and 14%), but the researchers noted that recurrence was lower than adult studies, which have a range of between 20% and 30%.

“Predictors of recurrence in adult studies included older age group, initial C difficile infection disease severity, and hospitalization at time of [infection] diagnosis,” the study authors explained. “Older age is a consistent strong predictor of recurrent C difficile infection that may explain the higher recurrence rate in adult studies compared with that of pediatric literature.”

The study, titled “Trends and Predictors of Clostridium difficile Infection among Children: A Canadian Population-Based Study,” was published in The Journal of Pediatrics.