Objective:Hospital-and population-based studies demonstrate an increasing incidence of Clostridium difficile infection(CDI)in adults and children;although pediatric CDI outcomes are incompletely understood.We analysed...Objective:Hospital-and population-based studies demonstrate an increasing incidence of Clostridium difficile infection(CDI)in adults and children;although pediatric CDI outcomes are incompletely understood.We analysed United States National Hospital Discharge Survey(NHDS)data to study CDI in hospitalized children.Methods:NHDS data for 2005–2009(demographics,diagnoses and discharge status)were obtained;cases and comorbidities were identified using ICD-9 codes.Weighted univariate and multivariate analyses were performed to ascertain incidence of CDI;associations between CDI and outcomes[length of stay(LOS),colectomy,all-cause in-hospital mortality and discharge to a care facility(DTCF)].Results:Of an estimated 13.8 million pediatric inpatients;46176 had CDI;median age was 3 years;overall incidence was 33.5/10000 hospitalizations.The annual frequency of CDI did not vary from 2005 to 2009(0.24–0.43%;P=0.64).On univariate analyses,children with CDI had a longer median LOS(6 vs 2 days),higher rates of colectomy[odds ratio(OR)2.0;95%confidence interval(CI)1.7–2.4],mortality(OR 2.5;95% CI 2.3–2.7),and DTCF(OR 1.6;95% CI 1.6–1.7)(all P<0.0001).After adjusting for age,sex and comorbidities,CDI was an independent and the strongest predictor of increased LOS(adjusted mean difference,6.4 days;95% CI 5.4–7.4),higher rates of colectomy(OR 2.1;95% CI 1.8–2.5),mortality(OR 2.3;95% CI 2.2–2.5),and DTCF(OR 1.7;95% CI 1.6–1.8)(all P<0.0001).On excluding infants from the analysis,children with CDI had higher rates of mortality,DTCF and longer LOS than children without CDI.Conclusions:Despite increased awareness and advancements in management,CDI remains a significant problem and is associated with increased LOS,colectomy,in-hospital mortality and DTCF in hospitalized children.展开更多
文摘Objective:Hospital-and population-based studies demonstrate an increasing incidence of Clostridium difficile infection(CDI)in adults and children;although pediatric CDI outcomes are incompletely understood.We analysed United States National Hospital Discharge Survey(NHDS)data to study CDI in hospitalized children.Methods:NHDS data for 2005–2009(demographics,diagnoses and discharge status)were obtained;cases and comorbidities were identified using ICD-9 codes.Weighted univariate and multivariate analyses were performed to ascertain incidence of CDI;associations between CDI and outcomes[length of stay(LOS),colectomy,all-cause in-hospital mortality and discharge to a care facility(DTCF)].Results:Of an estimated 13.8 million pediatric inpatients;46176 had CDI;median age was 3 years;overall incidence was 33.5/10000 hospitalizations.The annual frequency of CDI did not vary from 2005 to 2009(0.24–0.43%;P=0.64).On univariate analyses,children with CDI had a longer median LOS(6 vs 2 days),higher rates of colectomy[odds ratio(OR)2.0;95%confidence interval(CI)1.7–2.4],mortality(OR 2.5;95% CI 2.3–2.7),and DTCF(OR 1.6;95% CI 1.6–1.7)(all P<0.0001).After adjusting for age,sex and comorbidities,CDI was an independent and the strongest predictor of increased LOS(adjusted mean difference,6.4 days;95% CI 5.4–7.4),higher rates of colectomy(OR 2.1;95% CI 1.8–2.5),mortality(OR 2.3;95% CI 2.2–2.5),and DTCF(OR 1.7;95% CI 1.6–1.8)(all P<0.0001).On excluding infants from the analysis,children with CDI had higher rates of mortality,DTCF and longer LOS than children without CDI.Conclusions:Despite increased awareness and advancements in management,CDI remains a significant problem and is associated with increased LOS,colectomy,in-hospital mortality and DTCF in hospitalized children.
