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Incidence and risk factors for recurrent Clostridioides difficile infection in pediatric at-risk groups in selected Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) hospitals

Published online by Cambridge University Press:  13 September 2023

Lucila Baldassarre
Affiliation:
Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Québec, Canada
Caroline Quach-Thanh*
Affiliation:
Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Québec, Canada Centre Hospitalier Universitaire Sainte Justine Research Centre, Montreal, Québec, Canada
Verinsa Mouajou Feujio
Affiliation:
Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Québec, Canada
Fazia Tadount
Affiliation:
Centre Hospitalier Universitaire Sainte Justine Research Centre, Montreal, Québec, Canada
Claudia Deyirmendjian
Affiliation:
Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Québec, Canada
Marie-Astrid Lefebvre
Affiliation:
Division of Infectious Diseases, Department of Paediatrics, The Montreal Children’s Hospital of the McGill University Health Centre, Montreal, Québec, Canada
Nisha Thampi
Affiliation:
Children’s Hospital of Eastern Ontario, Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Ottawa, Ontario, Canada
Oliver Schneider
Affiliation:
Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Québec, Canada
Isabela Fabri-Karam
Affiliation:
Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
Shauna O’Donnell
Affiliation:
Infection Prevention & Control, Centre Hospitalier Universitaire Sainte Justine, Montreal, Québec, Canada
James Okeny-Owere
Affiliation:
Children’s Hospital of Eastern Ontario, Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Ottawa, Ontario, Canada
N. Audy
Affiliation:
Infection Prevention & Control, Centre Hospitalier Universitaire Sainte Justine, Montreal, Québec, Canada
Nadia Desmarais
Affiliation:
Infection Prevention & Control, Centre Hospitalier Universitaire Sainte Justine, Montreal, Québec, Canada
*
Corresponding author: Caroline Quach-Thanh; Email: caroline.quach-thanh.med@ssss.gouv.qc.ca

Abstract

Objectives:

Incidence and risk factors for recurrent Clostridioides difficile infection (rCDI) are well established in adults, though data are lacking in pediatrics. We aimed to determine incidence of and risk factors for rCDI in pediatrics.

Methods:

This retrospective cohort study of pediatric patients was conducted at 3 tertiary-care hospitals in Canada with laboratory-confirmed CDI between April 1, 2012, and March 31, 2017. rCDI was defined as an episode of CDI occurring 8 weeks or less from diagnostic test date of the primary episode. We used logistic regression to determine and quantify risk factors significantly associated with rCDI.

Results:

In total, 286 patients were included in this study. The incidence proportion for rCDI was 12.9%. Among hospitalized patients, the incidence rate was estimated at 2.6 cases of rCDI per 1,000 hospital days at risk (95% confidence interval [CI], 1.7–3.9). Immunocompromised patients had higher incidence of rCDI (17.5%; P = .03) and higher odds of developing rCDI independently of antibiotic treatment given for the primary episode (odds ratio [OR], 2.31; 95% CI, 1.12–5.09). Treatment with vancomycin monotherapy did not show statistically significant protection from rCDI, independently of immunocompromised status (OR, 0.33; 95% CI, 0.05–1.15]).

Conclusions:

The identification of increased risk of rCDI in immunocompromised pediatric patients warrants further research into alternative therapies, prophylaxis, and prevention strategies to prevent recurrent disease burden within these groups. Treatment of the initial episode with vancomycin did not show statistically significant protection from rCDI.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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