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Clostridium Infection on the Rise in Hospitalized Kids

Bacterial Infection Increased Nearly 15% Yearly From 1997 to 2006, Study Finds

By Kathleen Doheny
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 4, 2011 -- The number of hospitalized children infected by a potentially dangerous bacterium is on the rise, according to a new study.

The infection occurs from bacteria known as Clostridium difficile, which affects the gastrointestinal tract and can be deadly. These infections among hospitalized children rose nearly 15% a year during the time period studied, 1997 to 2006.

''If a child gets Clostridium difficile, they are more likely to die than those without the diagnosis, and they are more likely to require surgery of the colon and have a more complex hospital stay," says researcher Cade M. Nylund, MD, an assistant professor of pediatrics at the Uniformed Services University of the Health Sciences in Bethesda, Md.

The study is published online in the Archives of Pediatrics & Adolescent Medicine.

C.diff is common in hospitals and is also found in the community.

Clostridium Infection: Study Details

Nylund and his colleagues evaluated the records of hospitalized children from a national database of patients who were discharged from hospitals in the years 1997, 2000, 2003, and 2006.

The database included about 10.5 million children, and 0.2%, or 21,274, were infected.

Nylund decided to take a look while he was at the Cincinnati Children's Hospital Medical Center in Cincinnati because of the large number of infections he saw there. His daughter was infected at age 6, but recovered.

Nylund and his co-researchers found that children with the infection:

  • Had a 20% increased risk of dying compared to children without the diagnosis
  • Were 36% more likely to need colon surgery
  • Were more than four times as likely to have a longer hospital stay.

Children who have inflammatory bowel disease and children with a suppressed immune system (from chemotherapy or HIV, for instance) are at higher risk of becoming infected, he says.

Explaining Rising Cases of Clostridium Difficile

Exactly why the infection is increasing among hospitalized children is not known, the researchers say.

"Increasing awareness is part of it," says researcher Mitchell B. Cohen, MD, director of the division of gastroenterology, hepatology, and nutrition at Cincinnati Children's Hospital Medical Center.

"Antibiotic exposure used to be thought to be required," he says. "Now, it's considered a risk factor," with not all who become infected taking antibiotics.

In fact, antibiotic use went down during the study period, other research shows.

The database did not include information on whether the children were on antibiotics, Nylund says, so he can't say how much that may have boosted risk.

Another possibility is that a more virulent strain of the bacterium is circulating.

Catching Clostridium Difficile Early

Although some children infected with the bacteria don't have symptoms, in others persistent diarrhea can be a warning, the researchers say.

Researchers studied the infection only in hospitalized children, but it can also occur in other children, they say.

If children have persistent diarrhea - lasting longer than a week -- parents are advised to consult the pediatrician about testing for the infection, Cohen says.

''If your child starts to develop diarrhea or GI upset while in the hospital, make sure you bring it to your physician's attention," Nylund says.

Prevention is best, he tells WebMD. Parents can be sure their hospitalized child's health care providers pay close attention to hand-washing, he says, which can reduce the risk of infection.

Clostridium Rates: Second View

The rising rates of infection are no surprise, says Steven Czinn, MD, professor and chair of pediatrics at the University of Maryland School of Medicine, Baltimore, who reviewed the study findings for WebMD.

"There have been a number of reports over the past few years also suggesting a significant increase in CDI (Clostridium difficile infections) in both hospitalized adult and pediatric populations," he says.

"CD bacterial spores are quite hardy and can survive in the environment for months, allowing the spores to be transferred from one patient to the next by hospital personnel," he says.

The good news, he says, is that doctors and hospitals have become more aware of the risk of the infection. He agrees with the researchers that parents can reduce the risk for their child by being sure all hospital workers wash their hands when entering the hospital room.

SOURCES:

Nylund, C. Archives of Pediatrics & Adolescent Medicine, published online Jan. 3, 2011.

Cade Nylund, MD, assistant professor of pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md.

Mitchell Cohen, MD, director, division of gastroenterology, hepatology and nutrition, Cincinnati Children's Hospital Medical Center, Ohio.

Steven J. Czinn, MD, professor and chair of pediatrics, University of Maryland School of Medicine, Baltimore.

© 2011 WebMD, LLC. All rights reserved.



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