A34 TRENDS AND PREDICTORS OF CLOSTRIDIUM DIFFICILE INFECTION AMONG THE CHILDREN OF MANITOBA: A POPULATION-BASED STUDY

Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality in both children and adults. Clostridium difficile causes a wide spectrum of clinical illnesses, from asymptomatic colonization and mild diarrhea to pseudomembranous colitis and toxic megacolon. CDI is not adequately characterized in the pediatric age group. Our objectives were to examine: (a) trends in CDI rates, and (b) predictors of CDIs, including recurrent CDIs, in the pediatric population. Data were extracted from several validated population-based datasets from the province of Manitoba for the period from 2005 to 2015. CDI was identified from a laboratory-confirmed CDI dataset. Children aged 2–17 years with CDI were matched to children without CDI, based on age, sex, 3-digit residential postal code and duration of coverage with Manitoba Health (MH) prior to the index date (i.e., date of first CDI). Children younger than 2 years of age were excluded on the basis of apparent lack of association between carriage and disease. Rates and time trends of CDIs using previously recommended definitions were determined. Predictors of CDI sub-types were determined using multivariable logistic regression models. CDIs diagnosed in outpatient and hospital settings were identified. Cox regression analysis was used to assess for the potential predictors of CDI, including age, sex, socio-economic status (SES), co-morbidities burden, and medications used. Over the study period, 277 children with CDI were identified and matched with 1314 controls without CDI. After excluding those who had CDI before the age of 2 years old, 193 CDI from 163 children (47% males) were included. Children with and without CDI were followed for 828 and 2753 persons years respectively. There was no significant increase in CDI rates over the observation period. Children with CDI had significantly higher number of outpatient clinic visits compared to controls in the year before CDI diagnosis (p<0.0001). Co-morbid conditions that were more prevalent among children with CDI than matched controls included Hirschsprung’s disease (p<0.001) and inflammatory bowel disease (p<0.0001). More than half of CDIs were community acquired and 18.7% were healthcare facility associated. Recurrent CDIs were responsible for 10.4% of CDI episodes (range 2–6 infections). Predictors of recurrence included malignancy (Hazard ratio (HR)= 3, 95% 1.1–8.8), Type 1 diabetes (HR=4.8, 95% CI 1.1–21.4) and neurodegenerative diseases (HR=8.4, 95% CI 1.9–37.5). The incidence of CDI is not increasing among children in Manitoba. Community-acquired CDI is much more common than healthcare facility-associated. Children with malignancy, type 1 diabetes and neurodegenerative disorders are more likely to have recurrent CDI. This work was supported with an unrestricted grant from MERCK

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