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More Children Hospitalized With Severe Clostridium Difficile, Says Study

Cheryl Clark, for HealthLeaders Media, March 10, 2010

The strain of clostridium difficile causing severe disease in children has been increasing from 7.24 per 10,000 hospitalizations in 1997 to 12.8 in 2006, most of it during the latter six years.

That's according to a paper published today in the Journal Emerging Infectious Diseases, a public health journal produced by the Centers for Disease Control and Prevention.

The study's author, Marya Zilberberg, associate professor of epidemiology at the University of Massachusetts School of Public Health, says the finding should prompt health providers to be even more careful with the use of antibiotics, which may pave the way for the dramatic increase.

"The solution is complicated," she says. "But it certainly involves curbing the use of antibiotics, and using them only when necessary and only using a spectrum as broad as it needs to be and no broader. The fact of the matter is, and there are several studies that show this, physicians aren't educated about [proper] antibiotic use."

Zilberberg sums up the report by saying that if physicians and hospital personnel "don't curb the escalation of antibiotic use, we'll be right back in the pre-antibiotic era. Everybody's worried, and I truly believe that antibiotic resistance is one of the most important issues of our time in healthcare."

"A better understanding of the epidemiology and outcomes of CDI is urgently needed," according to her report's conclusions.

The report found that the lowest rate of C. difficile infections in children was for those under age 1, but the highest rates of increase were in those children between the ages of 1 and 4, with 44.87 per 10,000 hospitalizations, followed by children between ages 5 and 9, 35.27 per 10,000 hospitalizations.

Her report used a national survey of hospital discharges and the federal Healthcare Cost and Utilization Project based on ICD-9 codes to track cases.

Stuart Cohen, MD, infectious disease expert at the University of California at Davis who specializes in C. difficile, says for many years, the bacteria made hospitals nervous and edgy in fear of the havoc it caused in adults. For a long time, researchers and epidemiologists did not think the infection was a major threat for children too, he says.

Through this paper, that appears to be not true or to have changed.

"This study redefines the epidemiology of C. difficile for kids," he says.

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