Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T19:54:11.764Z Has data issue: false hasContentIssue false
  • English
  • Français

The Role of Clostridium difficile and Viruses as Causes of Nosocomial Diarrhea in Children

Published online by Cambridge University Press:  02 January 2015

Joanne M. Langley ,
John C. LeBlanc ,
Martha Hanakowski  and
Olga Goloubeva
Joanne M. Langley*
Affiliation:
Infection Control Services, Izaak Walton Killam Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
John C. LeBlanc
Affiliation:
Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
Martha Hanakowski
Affiliation:
Infection Control Services, Izaak Walton Killam Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
Olga Goloubeva
Affiliation:
Department Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada
*
Clinical Trials Research Centre Infectious Diseases, IWK Health Centre, Halifax, NS B3J 3G9, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

We report surveillance of nosocomial diarrhea in children at our institution during the past decade and note different epidemiology of diarrhea due to viruses and Clostridium difficile.

Design:

A prospective cohort study.

Setting:

A university-affiliated pediatric hospital with 180 beds serving an urban area and providing referral care for the Maritime Provinces of Canada.

Participants:

Children younger than 18 years.

Methods:

Surveillance was conducted from 1991 to 1999 using personal contact with personnel and review of microbiology and medical records. Nosocomial diarrhea was defined as loose stools occurring more than 48 hours after admission, with at least two loose stools in 12 hours and no likely non-infectious cause.

Results:

Nosocomial diarrhea was the third most common nosocomial infection (217 of 1,466; 15%), after bloodstream and respiratory infections, with from 0.5 to 1 episode per 1,000 patient-days. Of 217 nosocomial diarrhea episodes, 122 (56%) had identified pathogens: C. difficile (39 of 122; 32%), rotavirus (38 of 122; 31%), adenovirus (36 of 122; 30%), and other viral (9 of 122; 7%). The median age was 1.3 years (range, 11 days to 17.9 years), 0.80 year for children with viral diarrhea, 3.9 years for children with C. difficile, and 1.5 years for children with diarrhea without a causative organism identified (P< .0001). Most children with nosocomial diarrhea were incontinent (diapered) at the time of their first episode (138 of 185; 75%), but preexisting incontinence was more common in those with viral diarrhea (93%) compared with those with no organism identified (71%) or those with C. difficile-associated diarrhea (CDAD) (49%) (P< .0001).

Conclusions:

C. difficile is the single most common cause of nosocomial diarrhea in our tertiary-care center, although all viral pathogens account for 69% of cases. Diapered status appears to be a risk factor for CDAD in children, and CDAD occurs more often in older children than viral nosocomial diarrhea. Further characterization of risk factors for, and morbidity associated with, nosocomial CDAD in children is warranted.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 660 - 664
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hirschhorn, N, Greenough, WB 3rd. Progress in oral rehydration therapy. Sci Am 1991;264:50–56.CrossRefGoogle ScholarPubMed
2.Frost, F, Craun, GF, Calderon, RL. Increasing hospitalization and death possibly due to Clostridium difficile diarrheal disease. Emerg Infect Dis 1998;4:619–625.CrossRefGoogle ScholarPubMed
3.Ford-Jones, EL, Mindorff, CM, Langley, JM, et al. Epidemiologic study of 4,684 hospital-acquired infections in pediatric patients. Pediatr Infect Dis J 1989;8:668–675.CrossRefGoogle Scholar
4.Claeson, M, Merson, MH. Global progress in the control of diarrheal diseases. Pediatr Infect Dis J 1990;9:345–355.CrossRefGoogle ScholarPubMed
5.Johnson, S, Gerding, DN. Clostridium difficile-associated diarrhea. Clin Infect Dis 1998;26:1027–1034.Google Scholar
6.Kapikian, AZ. Overview of viral gastroenteritis. Arch Virol Suppl 1996; 12:7–19.Google Scholar
7.Jamieson, FB, Wang, EE, Bain, C, Good, J, Duckmanton, L, Petric, M. Human torovirus: a new nosocomial gastrointestinal pathogen. J Infect Dis 1998;178:1263–1269.Google Scholar
8.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.CrossRefGoogle ScholarPubMed
9.Langley, JM, Hanakowski, M, Bortolussi, R. Demand for isolation beds in a pediatric hospital. Am J Infect Control 1994;22:207–211.CrossRefGoogle Scholar
10.Brady, MT, Pacini, DL, Budde, CT, Connell, MJ. Diagnostic studies of nosocomial diarrhea in children: assessing their use and value. Am J Infect Control 1989;17:77–82.Google Scholar
11.Bennet, R, Hedlund, KO, Ehrnst, A, Eriksson, M. Nosocomial gastroenteritis in two infant wards over 26 months. Acta Paediatr 1995;84:667–671.Google Scholar
12.Tessema, T. Risk factors for the development of diarrhoea in the neonatal ward of Ethio-Swedish Children's Hospital. East Afr Med J 1994; 71:384–387.Google Scholar
13.Dutta, P, Bhattacharya, SK, Saha, MR, Dutta, D, Bhattacharya, MK, Mitra, AK. Nosocomial rotavirus diarrhea in two medical wards of a pediatric hospital in Calcutta. Indian Pediatr 1992;29:701–706.Google ScholarPubMed
14.Dutta, P, Mitra, U, Rasaily, R, et al. Prospective study of nosocomial enteric infections in a pediatric hospital, Calcutta. Indian Pediatr 1993; 30:187–194.Google Scholar
15.Aye, DT, Bact, D, Sack, DAWachsmuth, IK, Kyi, DT, Thwe, SM. Neonatal diarrhea at a maternity hospital in Rangoon. Am J Public Health 1991; 81:480–481.Google Scholar
16.Roy, TE, McDonald, S, Patrick, ML, Keddy, JA. A survey of hospital infection in a pediatric hospital. Can Med Assoc J 1962;87:531–538.Google Scholar
17.Gardner, P, Carles, DG. Infections acquired in a pediatric hospital. J Pediatr 1972;81:1205–1210.CrossRefGoogle Scholar
18.Welliver, R, McLaughlin, S. Unique epidemiology of nosocomial infections in a children's hospital. American Journal of Diseases in Children 1984;138:131–135.Google Scholar
19.Pickering, L, Reves, R. Diarrhea. In: Donowitz, LJ, ed. Hospital-Acquired Infection in the Pediatric Patient. Baltimore: Williams and Wilkins; 1988:56–74.Google Scholar
20.Center for Disease Control. National Nosocomial Infections Study Report Annual Summary 1977. Atlanta, GACenter for Disease Control; 1979.Google Scholar
21.Ford-Jones, EL, Mindorff, CM, Gold, R, Petric, M. The incidence of viral-associated diarrhea after admission to a pediatric hospital. Am J Epidemiol 1990;131:711–718.Google Scholar
22.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
23.Wehl, G, Allerberger, F, Heitger, A, Meister, B, Maurer, K, Fink, FM. Trends in infection morbidity in a pediatric oncology ward, 1986-1995. Med Pediatr Oncol 1999;32:336–343.Google Scholar
24.Ferroni, A, Merckx, J, Ancelle, T, et al. Nosocomial outbreak of Clostridium difficile diarrhea in a pediatric service. Eur J Clin Microbiol Infect Dis 1997;16:928–933.Google Scholar
25.Rexach Zellhoefer, C, Tang, Y, Cohen, S. Isolation and molecular characterization of Clostridium difficile from children. Presented at the 39th Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 26-28,1999; San Francisco, CA.Google Scholar
26.Kato, H, Kato, N, Watanabe, K, et al. Application of typing by pulsed-field gel electrophoresis to the study of Clostridium difficile in a neonatal intensive care unit. J Clin Microbiol 1994;32:2067–2070.CrossRefGoogle Scholar
27.Enad, D, Meislich, D, Brodsky, NL, Hurt, H. Is Clostridium difficile a pathogen in the newborn intensive care unit? A prospective evaluation. J Perinatol 1997;17:355–359.Google Scholar
28.Burgner, D, Siarakas, S, Eagles, G, McCarthy, A, Bradbury, R, Stevens, M. A prospective study of Clostridium difficile infection and colonization in pediatric oncology patients. Pediatr Infect Dis J 1997;16:1131–1134.Google Scholar
29.Gryboski, JD, Pellerano, R, Young, N, Edberg, S. Positive role of Clostridium difficile infection in diarrhea in infants and children. Am J Gastroenterol 1991;86:685–689.Google Scholar
30.Waters, V, Ford-Jones, EL, Petric, M, Fearon, M, Corey, P, Moineddein, R. Etiology of community-acquired pediatric viral diarrhea: a prospective longitudinal study in hospitals, emergency departments, pediatric practices and child care centers during the winter rotavirus outbreak, 1997 to 1998. Pediatr Infect Dis J 2000;19:843–848.Google Scholar
31.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
32.Church, DL, Cadrain, G, Kabani, A, Jadavji, T, Trevenen, C. Practice guidelines for ordering stool cultures in a pediatric population: Alberta Children's Hospital, Calgary, Alberta, Canada. Am J Clin Pathol 1995; 103:149–153.CrossRefGoogle Scholar
33.Matlow, A, Streitenberger, L. Nosocomial salmonellosis: implications for microbiologic processing of stools in hospitalized patients. Am J Infect Control 2001;29:65–66.Google Scholar
34.Zaidi, AK, Macone, A, Goldmann, AD. Impact of simple screening criteria on utilization of low-yield bacterial stool cultures in a Children's Hospital. Pediatrics 1999;103:1189–1192.Google Scholar
35.DeWitt, TG. Acute diarrhea in children. Pediatr Rev 1989;11:6–13.CrossRefGoogle ScholarPubMed