Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.
The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).
The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.
"The high C. difficile infection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficile infection because the medication can change or kill beneficial bacteria that protect against infection.
Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.
"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."
Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.
This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.