risk factors for death in pediatric cdi 1185
table 1. Baseline Patient Demographics and Clinical Characteristics of the Cohort Characteristics
No. of Patients with
Male Race
White
Nonwhite Missing
Any Comorbidities No. of comorbidities None 1–2 ≥3
Comorbidities by category Malignancy
Cardiovascular disease Respiratory disease Renal disease
Gastrointestinal disease Hematologic/Immunologic Genetic/Congenital Metabolic disorder
Neuromuscular disease
Markers of severity of illness (48 hours prior) Receipt of pressorsa Admission to ICU
Receipt of respiratory supportb
Other exposures (30 days prior to CDI test) Antibiotics (90 days)
Gastric acid suppressionc TPN
Treatment (any)
Metronidazole only Oral vancomycin only Both
CDI (n=7,318), No. (%) 3,787 (51.8)
4,958 (67.8) 2,117 (28.9) 243 (3.3)
5479 (74.9) 1,839 (25.1)
4,917 (67.2) 562 (7.6)
2,306 (31.5) 788 (10.8) 530 (7.2) 311 (4.3) 772 (10.6) 494 (6.8) 799 (10.9) 807 (11.1) 1,333 (18.2)
374 (5.1)
1,277 (17.5) 1,342 (18.3)
5,233 (72.6) 4,289 (58.6) 1,259 (17.2) 5,518 (75.4) 5,093 (69.6) 178 (5.8) 247 (3.4)
NOTE. CDI, Clostridium difficile infection; ICU, intensive care unit; TPN, total parenteral nutrition. aDopamine, epinephrine, norepinephrine, dobutamine. bMechanical ventilation or supplemental oxygen. cProton pump inhibitors or H2 blockers.
receipt of total parenteral nutrition (TPN) within 30 days, LOS prior to C. difficile test, and CO-CDI. History of and type of comorbid condition was also associated with death. We did not find an association with C. difficile treatment and in- hospital mortality. Multivariable analysis identified several independent risk
factors for in-hospital 30-day mortality (Table 2). These risk factors include older age [adjusted odds ratio (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)], receipt of gastric acid suppression 30 days prior to C. difficile test [2.70 (1.43–5.08)], and presence of >1 marker of severity of illness [3.88 (2.44–6.19)]. Figure 1 represents the predicted probability of in-hospital mortality for children hospitalized with CDI who have ≥1 independent risk factor from the
multivariable model. Older children, children receiving gastric acid suppression, children with a history of certain comorbid conditions (cardiovascular disease, hematologic or immunolo- gic condition, or malignancy), and children with 1 or 2 severity of illness markers had a ~2%–3% probability of death. Having all 3 severity of illness markers increased the probability of death to ~10%. Older children with 1 of the comorbid conditions and all 3 severity of illness markers in conjunction with receipt of gastric acid suppression had a ~30%–35%probability of death, depending on the type of condition.
Secondary Outcome: Risk Factors for CDI-Related Readmission
Among 5,186 children treated for CDI, 225 (4.3%) were readmitted within 8 weeks of their index CDI episode.
No. of Deaths
(n=109), No. (%) 56 (51.4)
67 (61.5) 36 (33.0) 6 (5.5)
102 (93.6) 7 (6.4)
85 (78.0) 17 (15.6)
58 (53.2) 30 (27.5) 6 (5.5)
10 (9.2) 5 (4.6)
15 (13.8) 16 (14.7) 12 (11.0) 26 (23.9)
35 (32.1) 62 (56.9) 56 (51.4)
106 (97.3) 97 (89.0) 46 (42.2) 88 (80.7) 78 (78.0) 3 (2.8) 7 (6.4)
<.0001 <.0001 .481 .017 .040 .003 .204 .995 .124
<.0001 <.0001 <.0001
<.0001 <.0001 <.0001 .193 .653 .749 .098
<.0001 <.0001
P Value .937
.237
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