Results
From July 2003 to July 2012, 202 pediatric inpatients with the clinical diagnosis of CDI were identified and 175 patients met eligibility criteria. Nine cases were excluded as their presenting episode was recurrent disease and 18 were excluded as no follow-up information was available after 8 weeks from discharge. Twenty-one episodes (12%) were first recurrences of children with prior CDI, with mean time to recurrence of 34 days (range 11–58 days).
After introduction of polymerase chain reaction for diagnosis of CDI (2009–2012), the rates ranged from 2.7/1000 admissions to 6.6/1000 admissions, when compared with 1.8/1000 admissions to 3.8/1000 admissions from 2003 to 2007.
Patients with recurrence tended to be younger (median 3.8 vs. 9.9 years) and their initial CDI episode was more commonly classified as community-associated (38.1% vs. 15.6%), rather than HO-HCFA CDI (28.6% vs. 53.3%) when compared with patients without recurrence (see Table , Supplemental Digital Content 1, http://links.lww.com/INF/B719). Neither disease severity nor therapy received differed between the 2 groups. Patients with recurrence tended to have received additional antibiotics prescribed for non-CDI indications during their course of treatment for their initial episode of CDI (71.4% vs. 49.4%, P = 0.06). The most common antibiotics continued during CDI treatment were trimethoprim/sulfamethoxazole (42.9%), penicillins (27.5%), cephalosporins (26.4%) aminoglycosides (22.0%), macrolides (16.5%), carbapenems (11%), quinolones (7.7%) and clindamycin (2.2%). There was no association with recurrence for any single class of antibiotics, antacids or antiretrovirals administered concomitantly (data not shown).
Both community-associated CDI and receipt of additional antibiotics were included in a multivariable logistic regression model and were independently associated with recurrent disease (OR: 5.07, 95% confidence interval: 1.71–15.07, P = 0.003 and OR: 3.85, 95% confidence interval: 1.28–11.58, P = 0.02).