March 19, 2014
Children’s C. Difficile Usually Linked to Antibiotic Prescriptions

Atlanta—Most cases of pediatric Clostridium difficile infections can be linked to recent antibiotic prescriptions for other conditions, according to a new study from the CDC.

The study, published recently in the journal Pediatrics, indicated that 71% of the 944 cases of C. difficile infection identified among children aged 1 through 17 years old were community-associated. In comparison, two-thirds of C. difficile infections in adults are associated with hospital stays.

C. difficile, which causes severe diarrhea, can sometimes be life-threatening, especially in children, according to public health officials. No deaths were documented in the cases reviewed for this study.

Based on a survey of parents, the CDC found that 73% of the children were prescribed antibiotics during the 12 weeks prior to their illness, usually in an outpatient setting such as a physician’s office. In most cases, the antibiotics were prescribed for ear, sinus, or upper respiratory infections—many of which do not require anti-bacterials.

“Improved antibiotic prescribing is critical to protect the health of our nation’s children,” said CDC Director Tom Frieden, MD, MPH. “When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C. difficile infection and dangerous antibiotic resistant infections.”

C. difficile incidence per 100,000 children was highest among white (23.9) 1-year-olds (66.3). The proportion of cases with documented diarrhea, 72%, or severe disease, 8%, was similar across age groups, according to the report.

“Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates…observed in younger children,” the authors write. “Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.”

Friedan noted that funding has been requested in the 2015 federal budget for the CDC to improve outpatient antibiotic prescribing practices and protect patients from infections, such as those caused by C. difficile.

The CDC initiative seeks to reduce outpatient prescribing by up to 20% and healthcare-associated C. difficile infections by 50%. If successful, 20,000 lives could be saved, 150,000 hospitalizations prevented, and more than $2 billion in healthcare costs avoided, according to the agency.

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