Epidemiology and Risk Factors for Community Associated Clostridioides difficile in Children

J Pediatr. 2020 Jun:221:99-106. doi: 10.1016/j.jpeds.2020.02.005. Epub 2020 Mar 11.


Objective: To assess which risk factors are associated with community-associated Clostridioides difficile infection (CDI) in children.

Study design: This case control study was a retrospective review of all children 1-17 years of age with stool specimens sent for C difficile testing from January 1, 2012, to December 31, 2016. Cases and controls were children who had C difficile testing performed in the community or first 48 hours of hospital admission and >12 weeks after hospital discharge, with no prior positive C difficile testing in last 8 weeks, without other identified causes of diarrhea, and with clinical symptoms. Cases had positive confirmatory testing for C difficile. Controls had negative testing for C difficile and were matched to cases 1:1 by age and year of specimen collection.

Results: The overall incidence rate of community-acquired CDI in this cohort was 13.7 per 100 000 children per year. There was a substantial increase in community-acquired CDI from 9.6 per 100 000 children per year in 2012 to a peak of 16.9 per 100 000 children per year in 2015 (Cochran-Armitage test for trend P = .002). The risk factors for community-acquired CDI included non-Hispanic ethnicity; amoxicillin-clavulanate, cephalosporin, and clindamycin use within the previous 12 weeks; a previous positive C difficile test within 6 months; and increased health care visits in the last year.

Conclusions: As rates of community-acquired CDI are increasing, enhanced antibiotic stewardship and recognition of health care disparities may ease the burden of community-acquired CDI.

Keywords: diarrhea; pediatric.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Clostridiales*
  • Community-Acquired Infections / epidemiology
  • Female
  • Gram-Positive Bacterial Infections / epidemiology*
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Risk Factors