Fluoroquinolones Linked to Higher Pediatric C Difficile Hospitalization Rate

Danilo Buonsenso, MD

New research on pediatric patients with clostridium difficile infections (CDI) could ultimately result in future studies identifying risk factors within the pediatric population.

A team, led by Danilo Buonsenso, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, examined certain characteristics and risk factors for pediatric patients hospitalized with C difficile infections.

A Lack of Pediatric Studies

The majority of studies for C difficile infections have focused on the adult population, with very few targeting pediatric patients. While C difficile is more common in elderly patients with higher mortality rates, the rates of asymptomatic C difficile could be high in the pediatric population.

“One major explanation is the absence of toxin-binding receptors in the immature intestinal mucosa of children,” the authors wrote. “In recent years, the colonization rate has also increased in the pediatric population, even in the community setting.”

In the 5-year, retrospective study, the investigators examined 359 patients at 2 referral centers in Rome between January 2014 and December 2018. Of the 359 patients who were tested for C difficile infections, 87 were positive and 272 were negative.

The median age of the positive patients was 47 months.

Symptoms

In addition, 32.2% (n = 28) of hospitalized patients were admitted with gastrointestinal symptoms including diarrhea, vomiting, hemorrhagic diarrhea, abdominal pain, dehydration, and eating difficulties, while 17.2% (n = 15) of patients were hospitalized for follow-up, therapy, or surgery.

Finally, 21.8% (n = 19) of patients presented other symptoms, including cough, respiratory distress, rash, epileptic crisis, fever, edema, asthenia, hypotonia, and hematuria.

Treatments

Nearly all of the positive pediatric patients received treatment, with 31% (n = 27) of patients with mild or moderate symptoms treated with metronidazole and 4.6% (n = 4) treated with oral vancomycin.

Also, 13.8% (n = 12) of the patient population was treated with both, while 1.1% (n = 1) was treated with fecal microbiota transplant because of a serious condition. The remain 7 (8%) of patients were untreated.

The investigators also examined medical record information, including demographic and laboratory data, cause and duration of hospitalization, antibiotic and antiacid therapy, CDI treatment, and comorbidities.

Results

The investigators found pediatric patients with CDI had a higher number of previous-day hospital admissions (P = 0.024), hospitalizations (P = 0.001), and total hospital admissions (P = 0.008).

In addition, patients with chronic comorbidities frequently tested positive for C difficile (66.7% vs. 33.3%).

The investigators also found proton pump inhibitors and antibiotic use was linked to C difficile infections (P <0.001).

However, among specific antibiotics, only fluoroquinolone use was significantly associated with C difficile infections.

Pediatric patients with CDI were also more likely exposed to antibiotics during hospitalization.

“We provided an updated clinical, epidemiological, and risk factor analyses of children with CDI compared with a control group of children that tested negative,” the authors wrote. “Total hospitalizations, chronic comorbidities, and previous use of fluoroquinolones were significantly associated with CDI.”

The investigators suggest future research should target better defined risk factors and preventative measures.

The study, “Clostridioides difficile Infection in Children: A 5-Year Multicenter Retrospective Study,” was published online in Frontiers in Pediatrics.