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Antbiotics a prime risk factor for C. difficile in children

Monday March 10, 2014
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The majority of pediatric Clostridium difficile infections occur among children in the community who recently took antibiotics prescribed in doctor’s offices for other conditions, according to a CDC study.

As reported March 3 on the website of the journal Pediatrics, the researchers found 71% of the cases of C. difficile infection identified among children ages 1 through 17 were community-associated — that is, not associated with an overnight stay in a healthcare facility. By contrast, two-thirds of C. difficile infections in adults are associated with hospital stays.

Among the community-associated pediatric cases whose parents were interviewed, 73% were prescribed antibiotics during the 12 weeks prior to their illness, usually in an outpatient setting such as a doctor’s office. Most of the children who received antibiotics were being treated for ear, sinus or upper respiratory infections. According to a CDC news release, previous studies show that at least 50% of antibiotics prescribed in doctor’s offices for children are for respiratory infections, most of which do not require antibiotics.

“Improved antibiotic prescribing is critical to protect the health of our nation’s children,” CDC Director Tom Frieden, MD, MPH, said in a news release. “When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C. difficile infection and dangerous antibiotic resistant infections.”

The FY 2015 President’s Budget requests funding for CDC to improve outpatient antibiotic prescribing practices and protect patients from infections such as those caused by C. difficile. The CDC initiative aims to reduce outpatient prescribing by up to 20% and healthcare-associated C. difficile infections by 50% in five years. A 50% reduction in healthcare-associated C. difficile infections could save 20,000 lives, prevent 150,000 hospitalizations and cut more than $2 billion in healthcare costs.

C. difficile, which causes at least 250,000 infections in hospitalized patients and 14,000 deaths a year, remains at all-time high levels, according to the news release. According to preliminary CDC data, an estimated 17,000 children ages 1 through 17 get C. difficile infections every year. The Pediatrics study found no difference in the incidence of C. difficile infection among boys and girls, with the highest numbers seen in white children and those between the ages of 12 and 23 months.

Taking antibiotics is the most important risk factor for developing C. difficile infections for both adults and children, according to the CDC. When a person takes antibiotics, beneficial bacteria that protect against infection can be altered or even eliminated for several weeks to months. During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a healthcare provider’s hands.

Despite significant improvements in antibiotic prescribing for certain acute respiratory infections in children, further improvement is vital, according to the CDC. In addition, it is critical that parents avoid asking clinicians to prescribe antibiotics for their children and that clinicians follow prescribing guidelines.

Pediatrics study abstract: http://pediatrics.aappublications.org/content/early/2014/02/25/peds.2013-3049.abstract

More from the CDC on improving antibiotic prescribing practices in doctor’s offices: http://www.cdc.gov/getsmart


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