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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
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

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
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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