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Molecular Epidemiology of Clostridium difficile Infections in Children: A Retrospective Cohort Study

Published online by Cambridge University Press:  23 January 2015

Larry K. Kociolek ,
Sameer J. Patel ,
Stanford T. Shulman  and
Dale N. Gerding
Larry K. Kociolek*
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
Sameer J. Patel
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
Stanford T. Shulman
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
Dale N. Gerding
Affiliation:
Department of Medicine, Hines VA Hospital, Hines, Illinois Loyola University of Chicago, Stritch School of Medicine, Maywood, Illinois
*
Address correspondence to Larry K. Kociolek, MD, 225 E. Chicago Ave, Box 20, Chicago, IL 60611 (Larry-Kociolek@northwestern.edu).
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Abstract

OBJECTIVE

The molecular epidemiology of pediatric Clostridium difficile infection (CDI) is poorly understood. We aimed to identify the restriction endonuclease analysis (REA) groups causing CDI and to determine risk factors and outcomes associated with CDI caused by epidemic strains in children.

DESIGN

Retrospective cohort study

PATIENTS

Inpatients and outpatients >1 year old receiving care between December 2012 and December 2013

SETTING

An academic children’s hospital in Chicago, Illinois

METHODS

C. difficile PCR-positive stools were cultured, and C. difficile isolates were typed by REA. REA of isolates from patients with multiple CDIs was performed to differentiate relapse (infection with same strain) from reinfection (different strains) irrespective of time between CDIs.

RESULTS

A total of 189 CDIs occurred among 145 patients. REA groups were widely distributed. The BI/NAP1/027 strain caused CDI in only 1 patient. DH/NAP11/106, the predominant epidemic strain identified, was associated with the use of third- or fourth-generation cephalosporins (risk ratio [RR], 3.2; 95% confidence interval [CI], 1.1–9.9; P=.04). CDI relapse commonly occurred up to 20 weeks later. Compared with CDI caused by non-DH/NAP11/106 strains, CDI caused by DH/NAP11/106 was more likely to result in multiple CDI relapses (40% vs 8%; P=.05) among children with multiple CDIs.

CONCLUSIONS

REA identified the exceedingly low prevalence of BI/NAP1/027 and the high prevalence of DH/NAP11/106, a common epidemic strain in the United Kingdom that is less often reported in the United States. CDI relapse commonly occurred up to 20 weeks from the previous CDI. Defining recurrent CDI as that occurring only within 8 weeks of the original infection may lead to misclassification of some recurrent CDIs as new CDIs in children.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 445 - 451
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The findings reported in the present study were presented as abstracts at ID Week 2014 (October 10, 2014, in Philadelphia, Pennsylvania).

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