1186 infection control & hospital epidemiology october 2015, vol. 36, no. 10
table 2. Univariate and Multivariable Odds Ratios for In- Hospital Mortality in Children with C. difficile Infection (CDI)
Exposure Age ≥13 y
LOS prior
No. of comorbidities None 1–2
3 or more
Severity of illness markers None 1–2 3
Malignancy
Cardiovascular disease Renal disease
Gastrointestinal illness
Hematologic/ immunologic
Univariate OR (95% CI)
Multivariable OR (95% CI)
1.93 (1.31–2.86) 1.92 (1.28–2.89) 1.01 (1.01–1.02) Not significant
4.60 (2.12–9.70) Not significant 8.16 (3.37–19.79) Not significant
Reference Reference Reference Reference
No. of antibiotic classes 1.47 (1.34–1.60) Not significant Antibiotic (Y/N) 90 days prior to CDI test
4.32 (2.78–6.71) 3.88 (2.44–6.19) 22.85 (13.54–38.56) 19.20 (10.78–34.21)
12.70 (4.02–40.05) Not significant 2.51 (1.71–3.67) 3.57 (2.36–5.40)
3.23 (2.11–4.95) 2.06 (1.28–3.30) 2.32 (1.20–4.49) Not significant 0.40 (0.16–0.99) Not significant 2.24 (1.29–3.90) 1.89 (1.05–3.39)
Total parenteral nutrition 3.60 (2.46–5.30) Not significant Gastric acid suppression 5.82 (3.19–10.61) 2.70 (1.43–5.08) Antibiotics after CDI test (Y/N)
No. of antibiotic classes after CDI test
Healthcare onset
7.33 (2.98–18.00) Not significant 1.45 (1.32–1.58) Not significant 2.40 (1.61–3.61) Not significant
NOTE. OR, adjusted odds ratio; LOS, length of stay.
table 3. Univariate and Multivariable Odds Ratios for CDI-related Readmission Within 8 Weeks in Hospitalized Children with Clostridium difficile Infection (CDI)
Univariate Exposure
Age category, y 1–3 4–7
8–12 ≥13
Any comorbidities
No. of comorbidities None 1–2 ≥3
Malignancy
Cardiovascular disease Metabolic disease
LOS prior to C. difficile test
LOS after C. difficile test Healthcare onset CDI
Antibiotics after C. difficile test
OR (95% CI) Reference
0.65 (0.44–0.96) 0.88 (0.61–1.26) 0.64 (0.45–0.92) 2.52 (1.73–3.77)
Reference
2.62 (1.77–3.88) 1.76 (0.87–3.55) 2.00 (1.53–2.62) 0.39 (0.19–0.79) 1.57 (1.06–2.32) 0.97 (0.95–0.99)
0.97 (0.95–0.99) 0.06 (0.05–0.07) 1.37 (1.00–1.88)
NOTE. OR, adjusted odds ratio; LOS, length of stay.
The median number of days between C. difficile testing and CDI-related readmission was 22 (IQR, 13–34). Patients with a CDI-related readmission were more likely to have ≥1 comor- bidity [adjusted odds ratio (95% confidence interval), 2.63 (1.19–5.79)], underlying malignancy [1.68 (1.25–2.27)], or metabolic disease [1.58 (1.04–2.40)]. These patients were less likely to have cardiovascular disease [0.37 (0.18–0.80)] and hospital-onset CDI [0.51 (0.37–0.68)], and had a shorter LOS [0.97 (0.95–0.98)] (Table 3).
discussion
figure 1. Predicted probability and 95% confidence intervals of in-hospital mortality within 30 days in children hospitalized with Clostridium difficile infection (CDI) by risk-factor combinations. GAS, gastric acid suppression; SOI, severity of illness markers.
Over the past decade, the incidence of CDI increased. Recent pediatric studies suggest that CDI is associated with worse outcomes in children.5,9 Identifying subpopulations of children with CDI that are at an increased risk of in-hospital mortality could inform the development of targeted CDI pre- vention programs and identify subgroups for future research in the optimal management of pediatric CDI. In this large, multicenter cohort study of children hospitalized with CDI, older age, receipt of gastric acid suppression, presence of ≥1 severity of illness markers, and various underlying comorbid- ities (eg, cardiovascular disease, hematologic or immunologic condition, or malignancy) were independently associated with increased risk of mortality. Available data regarding CDI-associated outcomes and predictors of these poor outcomes among children are limited. Our finding that mortality among patients with CDI is
Multivariable OR (95% CI)
Reference
0.57 (0.38–0.85) Not significant 0.58 (0.41–0.84) 2.63 (1.19–5.79)
Reference
0.97 (0.49–1.90) Not significant 1.68 (1.25–2.27) 0.37 (0.18–0.80) 1.58 (1.04–2.40) Not significant
0.97 (0.95–0.98) 0.51 (0.37–0.68) Not significant
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