Increased age and proton pump inhibitors are associated with severe Clostridium difficile infections in children
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
53
Journal Issue
4
Pages
578-584
Date Issued
2020
Author(s)
Chang T.-H.
Hsu W.-Y.
Yang T.-I.
Abstract
Background: Clostridium difficile infection (CDI) is increasing in children. We aimed to compare the clinical characteristics between CDI and colonization and to identify the risk factors for severe diseases of CDI in children. Method: We retrospectively reviewed 124 children (1–18 years old) from 2011 to 2018. CDI was defined as diarrhea (?3 loose stool in the past 24 h) with confirmed toxigenic strain. Colonization was defined as presence of C. difficile without clinical symptoms. Severe diseases included ileus, acute kidney injury, gastrointestinal bleeding or mortality. Patients younger than 1 year old and coinfections with other enteric pathogens were excluded. Results: Among 124 patients with C. difficile identified, 49 of them fulfilled CDI definition and 75 had C. difficile colonization. Children with CDI were more likely to present with watery (74% vs. 1%, p < 0.01) and mucoid stool (25% vs. 7%, p < 0.01) and occult blood in stool (67% vs. 33%, p < 0.01) than children with colonization. In CDI cases, elevated age-adjusted creatinine (18% vs. 0%, p = 0.03) and hyponatremia (134 mEq/L vs. 137 mEq/L, p = 0.04) were found. Also, they had more complicated diseases (27% vs. 0%, p < 0.01). On multivariate analysis, age older than 4 years (adjusted odds ratio: 5.83; 95% confidence interval: 1.05–32.27) and proton pump inhibitor use (PPI) (adjusted odds ratio: 7.25; 95% confidence interval: 1.07–49.07) were the independent factors for severe diseases. Conclusions: Watery diarrhea, mucoid stool and occult blood in stool could differentiate CDI from colonization. Patients with increased age and previous PPI use were the independent risk factors for severe diseases in children. ? 2018
SDGs
Other Subjects
aflatoxin B; antibiotic agent; creatinine; proton pump inhibitor; steroid; proton pump inhibitor; acute kidney failure; age; all cause mortality; antibiotic therapy; Article; bacterial colonization; child; childhood disease; clinical feature; Clostridium difficile infection; comparative study; demography; disease severity; female; gastrointestinal hemorrhage; human; hyponatremia; ileus; major clinical study; male; mortality; occult blood; pathogenesis; real time polymerase chain reaction; retrospective study; risk factor; sensitivity and specificity; adolescent; age; Clostridium infection; diarrhea; feces; hospitalization; infant; microbiology; pathophysiology; preschool child; severity of illness index; Taiwan; Adolescent; Age Factors; Child; Child, Preschool; Clostridium Infections; Diarrhea; Feces; Female; Hospitalization; Humans; Infant; Male; Proton Pump Inhibitors; Retrospective Studies; Risk Factors; Severity of Illness Index; Taiwan
Publisher
Elsevier Ltd
Type
journal article