infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Risk Factors for In-Hospital Mortality among a Cohort of Children with Clostridium difficile Infection
Neika Vendetti, MPH;1,5 Theoklis Zaoutis, MD, MSCE;1,2,3,5 Susan E. Coffin, MD, MPH;1,2,3,4,5 Julia Shaklee Sammons, MD, MSCE1,2,4,5
objective. The incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI.
methods. A multicenter cohort of children with CDI, aged 1–18 years, was established among children hospitalized at 41 freestanding children’s hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model.
results. We identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2–13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7–20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40–3.77)], underlying malignancy [3.57 (2.36–5.40)], cardiovascular disease [2.06 (1.28–3.30)], hematologic/immunologic condition [1.89 (1.05–3.39)], gastric acid suppression [2.70 (1.43–5.08)], and presence of >1 severity of illness marker [3.88 (2.44–6.19)].
conclusion. Patients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies.
Infect. Control Hosp. Epidemiol. 2015;36(10):1183–1189
Clostridium difficile is the most commonly identified cause of infectious diarrhea in hospitalized adults and has been asso- ciated with significant morbidity and mortality.1,2 Recent studies have shown that the incidence of pediatric C. difficile infection (CDI) has increased over the past decade.3–5 The clinical spectrum of CDI in adults and children varies widely, ranging from self-limiting diarrhea to more severe CDI such as toxic megacolon, sepsis, or death.6–8 To date, available data regarding CDI-associated outcomes in
hospitalized children are limited. However, some evidence suggests that CDI among hospitalized children has been asso- ciated with poor outcomes resulting in significant morbidity and increased risk of death.5,9 A recent study found that CDI was associated with an over two-fold increase in mortality, longer LOS, and higher total hospital costs among hospitalized children who were otherwise similar in important demographic and clinical characteristics.9 However, factors associated with
poor outcomes among hospitalized children with CDI are poorly understood. Given the lack of understanding of outcomes associated
with CDI in children, we sought to identify risk factors for in-hospital 30-day mortality and a CDI-related readmission within 8 weeks among a cohort of hospitalized children with CDI.
materials and methods Study Design and Data Source
We performed a retrospective,multicenter cohort study to assess risk factors for in-hospitalmortality among hospitalized children with CDI. Data were obtained from the Pediatric Health Infor- mation System (PHIS) database, a comprehensive clinical and administrative database that contains information from 43
Affiliations: 1. Division of Infectious Disease, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; 2. Department of Pediatrics, Perelman
School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; 3. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; 4. Department of Infection Prevention and Control, The Children’s Hospital of Phila- delphia, Philadelphia, Pennsylvania; 5. Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0008. DOI: 10.1017/ice.2015.152 Received March 19, 2015; accepted June 5, 2015; electronically published July 2, 2015
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