Predictors of hospital-onset Clostridioides difficile infection in children with antibiotic-associated diarrhea

POLAT M., TAPISIZ A., Demirdağ T. B., Yayla B. C., KARA S., TEZER H., ...More

American Journal of Infection Control, vol.51, no.8, pp.879-883, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 51 Issue: 8
  • Publication Date: 2023
  • Doi Number: 10.1016/j.ajic.2022.12.004
  • Journal Name: American Journal of Infection Control
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, PASCAL, BIOSIS, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.879-883
  • Keywords: Antibiotic-associated diarrhea, Children, Clostridioides difficile infection, Hospital-onset
  • Dokuz Eylül University Affiliated: Yes


© 2022 Association for Professionals in Infection Control and Epidemiology, Inc.Background: This study aimed to determine the predictors of hospital-onset Clostridioides difficile infection (CDI) in pediatric patients with antibiotic-associated diarrhea (AAD) and to develop a predictive scoring system to identify at-risk patients. Methods: This retrospective case-control study included patients aged ≥2-18 years with AAD who underwent C. difficile polymerase chain reaction testing >3 days after hospital admission. Patients with hospital-onset CDI were selected as cases and matched with the control patients without CDI. Univariate and multivariate logistic regressions were used to determine predictors of CDI and to construct a prediction score for the outcomes of interest. Results: Sixty-five patients with hospital-onset CDI and 130 controls were enrolled. Independent predictors for CDI identified and combined into the prediction score included abdominal pain (adjusted odds ratio [95% confidence interval]: 7.940 [3.254-19.374]), hospitalization for ≥14 days before the onset of diarrhea (3.441 [1.034-11.454]), antibiotic use for ≥10 days before the onset of diarrhea (6.775 [1.882-24.388]), receipt of meropenem (4.001 [1.098-14.577]) and clindamycin (14.842 [4.496-49.000]). The area under the receiver operating characteristic curve for this score was 0.883. Conclusions: The presented scoring system can be easily applied by clinicians at the bedside to decide which patients with AAD are likely to have CDI.