ATLANTA – The incidence of Clostridium difficile infection in children in Monroe County, N.Y., was low, and most cases were mild and community acquired during 2009-2011, but a high proportion of children affected had underlying chronic medical conditions, surveillance data show.
Many cases in children followed exposure to traditional risk factors in the 2 weeks preceding C. difficile infection, including use of antibiotics in 48% of cases, and exposure to proton pump inhibitors in 15% of cases, Rebecca C. Smith reported in a poster at the International Conference on Emerging Infectious Diseases.
Photo courtesy CDC/D.Holdeman
Among those children with infection, 64% had an underlying medical condition. The underlying medical conditions in children with included asthma, malignancy, presence of a G-tube, or failure to thrive. This photo shows HIV colonies on a blood agar plate.
Surveillance for C. difficile infection in Monroe County was part of a Centers for Disease Control and Prevention Emerging Infections Program project initiated because of an increase in infections in hospitalized children, as well as increases of severe disease acquired in the community in individuals with no known exposures to risk factors such as health care and antibiotics. These increases occurred following emergence of the highly toxic, epidemic BI/NAP1/027 strain of C. difficile, said Ms. Smith of the University of Rochester (N.Y.).
Of 3,351 cases of C. difficile infection identified during the 2-year surveillance conducted between October 2009, and October 2011, 115 (3%) were in children, for a yearly incidence of 33.5 cases per 100,000 population. The median age of pediatric patients in this study was 5 years, with those aged 12-23 months comprising 24% of cases, she noted.
Most pediatric cases (71%) were community acquired, and 4 (3%) of the 115 children were hospitalized for the C. difficile infection.
Stool samples were collected in 31 children, and of these 90% grew C. difficile, and 26% of those were NAP1, Ms. Smith said.
Recurrences occurred in 23% of cases, which was a rate similar to that seen in the adult population with C. difficile infection, she noted.
Importantly, 64% of the children had an underlying medical condition. The underlying medical conditions in children with C. difficile infection included asthma, malignancy, presence of a G-tube, or failure to thrive, and these conditions may have increased the likelihood of having true disease, Ms. Smith said.
The findings suggest that further investigation of the risk of C. difficile infection in children with no traditional risk factors is warranted, she concluded.
Ms. Smith said she had had no relevant financial disclosures.