To evaluate the prevalence, risk factors and course of Clostridium difficile associated disease (CDAD) among children admitted to a Pediatric Intensive Care Unit (PICU) and compare to children with diarrhea who were tested negative for C.diff. C. diff infections are becoming more common among hospitalized patients and they affect patient safety and quality of care outcomes in ICU settings. There is a limited recent data especially among critically ill children.
After IRB approval, a retrospective chart review was conducted on all children (aged 1 mo to 21 years) admitted to a PICU that had been tested for C. diff during a 15-month period. Demographic and predisposing factors and outcomes were compared between two groups of patients with and without positive PCR test for C. difficile. Data that was recorded and analyzed from medical records included: age, sex, ethnicity, pre-existing medical conditions, medications (antibiotics and gastric acid suppressants) received within 4 weeks prior to the onset of diarrhea, use of probiotics, duration of diarrhea, recurrence and complications of C. difficile infection etc. Descriptive data is presented as mean for parametric continuous data or median for non-parametric data and as percentages for categorical data. Chi square tests and Mann-Whitney U/ Wilcoxon tests were used for statistical analyses.
Results During the study period, there were 2,131 admissions to the PICU. Of these, 116 patients (5.4%) were tested for C. difficile; a total of 32 patients (1.5%) were C. diff PCR positive (Cd+) and developed CDAD, while the other 84 tested negative (Cd-). Age of patients, gender distribution, median duration of hospitalization and duration of diarrhea before C. diff testing and total duration of diarrhea were not significantly different between two groups. PIM2Score (-3.26 vs -4.48) and PIM2 risk of mortality (3.71% vs 1.14%) were significantly higher among Cd+ (P<0.05). Gender and racial distribution and rates of immunosuppression, malignancy, sepsis, co-infections, malnutrition, GER, and chronic lung disease and the rate of use of gastric acid suppression were similar between two groups. Prior antibiotic use was lower (75% vs 92%) and past history of C.diff infection (18.6% vs 4.8%), rates of mechanical ventilation (47% vs 27%), and septic shock (9% vs 2%) were higher among Cd+ patients (p<0.05). Mortality rate was similar in both groups.
The incidence of C. difficile associated disease in a PICU is 1.5% with a case fatality rate of 3.1%. CDAD is common among children with prior history of C. diff infection, sicker patients, and who are on mechanical ventilation. Use of antibiotics or gastric acid suppressants was not found to be associated with a higher incidence of CDAD.