Introduction
C. difficile infection (CDI) is the most common pathogen causing health care–associated infections (HCAI) in the United States, accounting for 15% of all such infections. In the adult population, the incidence of CDI and number and severity of hospitalizations has been increasing in conjunction with the description of hypervirulent strains of C difficile between 2001 and 2012. More recent reports, including nationwide studies, have also shown that CDI has become an emerging problem in hospitalized children.
In children with Cystic Fibrosis (CF), several risk factors for C difficile  colonization exists, such as frequent hospitalizations and exposure to a broad array of antibiotics. Despite these risk factors, the occurrence of CDI in CF is reported to be rare. In recent years however, there has been a few case reports and small case series that have described severe complicated CDI in children with CF. Furthermore, an adult study indicated that patients with CF have a three-fold risk of developing CDI as compared to non-CF controls and CF patients with CDI have higher mortality, colectomy rates, length of stay, and hospital charges. Less is known about the impact of CDI on outcomes of CF hospitalizations.
We sought to compare the in-hospital mortality, Length of Stay (LOS) and healthcare charges between pediatric CF hospitalizations with and without CDI using a large, nationally representative database and explore time trends in the proportion of CF hospitalizations with concomitant CDI between 1997 to 2016.