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Clostridium difficile Infection in Children

Epidemiology and Trend in a Swedish Tertiary Care Hospital

Malmqvist, Lovisa MD*; Ullberg, Måns MD; Hed Myrberg, Ida BSc; Nilsson, Anna MD‡,§

The Pediatric Infectious Disease Journal: December 2019 - Volume 38 - Issue 12 - p 1208–1213
doi: 10.1097/INF.0000000000002480
Original Studies
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Background: Several studies have shown an increasing trend in pediatric Clostridium difficile infection (CDI). However, the Public Health Agency in Sweden reports a decreasing incidence of CDI in the Swedish population since 2007. The main aim of this study is to analyze the epidemiology of CDI in children.

Methods: Retrospective chart-review of patients 1 to <19 years old, positive for Clostridium difficile toxin B, tested at Karolinska University Hospital Units, over the time period from July 1, 2010 to June 30, 2018. Episodes were classified as recurrences (≥2 weeks, ≤8 weeks from previous episode) or new episodes (>8 weeks from previous episode). New episodes were classified as hospital- (HA-CDI) or community-associated (CA-CDI). Annual infection rates/100,000 children in the catchment area were calculated.

Results: Three hundred twenty-eight positive tests in 206 patients were included of which 259 (79.0%) tests were new episodes and 69 (21.0%) recurrences. In 63/206 (30.6%) children, >1 episode of CDI was recorded. The mean infection rate was 8.5/100,000 children. There was an overall increasing trend in CDI-rate July 2010–June 2018, however not statistically significant (P = 0.061) nor for the incidence in HA-CDI (P = 0.720) or CA-CDI (P = 0.179). Underlying medical conditions were present in 226/259 (87.3%) new episodes of which the most common was malignancy. Of the new episodes, 188/259 (72.6%) were HA-CDI and 46/259 (17.8%) were CA-CDI.

Conclusions: There was an increasing trend in CDI in children in Sweden from 2010 to 2018, although not statistically significant. CDI was associated with comorbid conditions and repeated episodes were common.

From the *Paediatric Oncology Department, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

Microbiology Department, Karolinska University Hospital, Stockholm, Sweden

Department of Women’s and Children’s health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden

§Paediatric Oncology Department, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.

Accepted for publication August 26, 2019.

The authors have no conflicts of interest or funding to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com)

Address for correspondence: Lovisa Malmqvist, MD, Paediatric Residency Program, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Huddinge, 141 68 Stockholm, Sweden. E-mail: lovisa.malmqvist@sll.se.

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