Infection Control & Hospital Epidemiology
be representative of the risk factors for hospitalized patients. As a result, the number of eligible studies was limited in our analysis. Second, contemporary practice guidelines recommend the use of nucleic acid amplification test over the use of other modalities in the diagnosis of CDI.9 Due to the paucity of new studies of CDI in pediatric patients, however, most of the studies included in this meta-analysis are older and utilized previously accepted methods such as toxin EIA (Table 1). Third, we evaluated antibi- otic exposure as a composite variable without clarifying the specific antibiotics used and duration of treatment because few studies had reported this information. In reality, select antibiotics may have greater effects on CDI compared to others.23 Fourth, although our meta-analysis incorporated studies representing >10 million patients overall, several studies with large sample size, particularly that of Nylund et al3 did not provide data on important risk factors such as antibiotic exposure and PPI use. A final limitation is the utilization of unadjusted studies that are especially prone to bias and confounding by additional variables. We performed subgroup analyses with only adjusted studies where possible, but we felt the limited number of studies justified the use of unadjusted studies for a preliminary examination of these risk factors. Additional adjusted studies of risk factors for pediatric inpatient CDI would provide the data for a more robust meta-analysis of these risk factors in the future. In conclusion, we found that antibiotic exposure and PPI use
may be risk factors for CDI infection in hospitalized pediatric patients. Clinicians should continue to utilize antibiotics judi- ciously in hospitalized patients to minimize the risk for CDI, and similar considerations may be beneficial prior to administra- tion of PPIs. Higher-quality adjusted studies of risk factors in the pediatric population with better defined study parameters and def- initions for risk factors are needed to validate these results and to further explore other potential risk factors, including the risk asso- ciated with specific antibiotic classes.
Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2019.23
Author ORCIDs. Scott Anjewierden, Pant, 2995
0000-0003-4599-7644; Abhishek Deshpande,
0000-0001-5542-1599; Chaitanya 0000-0001-5522-
Acknowledgments. None. Financial support. No financial support was provided relevant to this article.
Conflicts of interest. Abhishek Deshpande has received research support from 3M, Clorox, and STERIS unrelated to this study. All other authors report no conflicts of interest relevant to this article to disclose.
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