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.