Dissertation Details

Dissertation Code :  IDpq 3065300

Dissertation Title   :  The epidemiology of Clostridium difficile in pediatric patients


About This Dissertation

111 pages
Ph.D. dissertation
2002.

Abstract
To describe the epidemiology of C. difficile in pediatric patients, a study was conducted at Children's Hospital Central California, Madera (CHCC, N = 676) (7/98 to 1/99) and the University of California Medical Center Pediatric Hospital, Sacramento (UCDMC-PH, N = 232) (10/01 to 7/02). Stool samples received by the microbiology lab from pediatric patients were analyzed for C. difficile by culture and latex agglutination, and for the presence of toxin genes and DNA fingerprinting by PCR. Patient culture positive than patients at CHCC (OR = 3.07, 95%CI = 2.21, 4.28). Inpatient status (OR = 0.67, 95%CI = 0.47, 0.95) and use of H-2 antagonists (OR = 0.50, 95%CI = 0.32, 0.78) decreased risk of colonization, while underlying medical conditions (OR = 1.82, 95%CI = 1.24, 2.65) and exposure to two or more anti-infectives (OR = 1.82, 95%CI = 1.24, 2.65) increased risk of colonization. Colonization with a toxigenic strain was influenced by use of H-2 antagonists (OR = 0.35, 95%CI = 0.20, 0.63), underlying conditions (OR = 2.24, 95%CI = 1.34, 3.74), and exposure to two or more anti-infectives (OR = 1.59, 95%CI = 1.04, 2.44). Higher odds of colonization and colonization with a toxin positive isolate were seen in children aged one (OR = 3.32, 95%CI = 1.78, 6.24 and OR = 3.46, 95%CI = 1.83, 6.53), three (OR = 3.21, 95%CI = 1.69, 6.09 and OR = 3.37, 95%CI = 1.74, 6.50), and 12 years (OR = 2.00, 95%CI = 1.04, 3.85 and OR = 2.21; 95%CI = 1.14, 4.29) than in one-month-olds. A separate analysis of inpatients at CHCC suggests that prior C. difficile infection encourages future colonization with a toxigenic strain (OR = 2.66, 95%CI = 1.10, 6.42). Molecular analysis of isolates from CHCC identified 13 toxigenic clusters, six nontoxigenic clusters, and 82 isolates with unique patterns. Spatial and temporal clustering among 67 isolates from inpatients in four CHCC wards was evaluated by Knox Test, resulting in detection of two clusters. AP-PCR identified five additional clusters undetected by the first method. At UCDMC-PH, 61% (38/62) of admission stools were culture positive and 92% of all isolates (109/118) had unique fingerprints. This suggests that C. difficile was primarily community acquired. These data suggest that the epidemiology of C. difficile in pediatric populations is different from what is reported for adults and that further investigation into the role of H-2 antagonists and underlying conditions in disease development is warranted.


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