Risk factors for community-associated Clostridioides difficile infection in young children

• Published in: Epidemiology and infection 2019-01, Vol.147, p.1-8, Article e172
• Main Authors: Weng, M. K., Adkins, S. H., Bamberg, W., Farley, M. M., Espinosa, C. C., Wilson, L., Perlmutter, R., Holzbauer, S., Whitten, T., Phipps, E. C., Hancock, E. B., Dumyati, G., Nelson, D. S., Beldavs, Z. G., Ocampo, V., Davis, C. M., Rue, B., Korhonen, L., McDonald, L. C., Guh, A. Y.
• Format: Article
• Language: English
• Subjects: Age groups; Antibiotics; Caregivers; Case-Control Studies; Child Day Care Centers - statistics & numerical data; Child, Preschool; Children; Clostridium difficile - physiology; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Diarrhea; Exposure; Female; Females; Food Microbiology - statistics & numerical data; Health care; Health care facilities; Health facilities; Humans; Illnesses; Incidence; Infant; Infections; Intensive care; Male; Medical laboratories; Medical records; Multivariable control; Original Paper; Outpatients - statistics & numerical data; Pathogens; Patients; Population; Regression analysis; Risk analysis; Risk exposure; Risk Factors; Studies; Surveillance; United States - epidemiology
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268819000372

The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.