Highlights
- •Significant predictors of Clostridioides difficile infection (CDI) included presence of abdominal pain, exposure to meropenem and clindamycin, longer duration of hospital stay and antibiotic treatment.
- •The new scoring system showed good discrimination, with an AUROC of 0.88.
- •The optimal cut-off point for the score was 6, with a sensitivity and specificity of 89% and 74%, respectively.
Abstract
Background
This study aimed to determine the predictors of hospital-onset Clostridioides difficile infection (CDI) in pediatric patients with antibiotic-associated diarrhea (AAD) and
to develop a predictive scoring system to identify at-risk patients.
Methods
This retrospective case-control study included patients aged ≥2-18 years with AAD
who underwent C. difficile polymerase chain reaction testing >3 days after hospital admission. Patients with
hospital-onset CDI were selected as cases and matched with the control patients without
CDI. Univariate and multivariate logistic regressions were used to determine predictors
of CDI and to construct a prediction score for the outcomes of interest.
Results
Sixty-five patients with hospital-onset CDI and 130 controls were enrolled. Independent
predictors for CDI identified and combined into the prediction score included abdominal
pain (adjusted odds ratio [95% confidence interval]: 7.940 [3.254-19.374]), hospitalization
for ≥14 days before the onset of diarrhea (3.441 [1.034-11.454]), antibiotic use for
≥10 days before the onset of diarrhea (6.775 [1.882-24.388]), receipt of meropenem
(4.001 [1.098-14.577]) and clindamycin (14.842 [4.496-49.000]). The area under the
receiver operating characteristic curve for this score was 0.883.
Conclusions
The presented scoring system can be easily applied by clinicians at the bedside to
decide which patients with AAD are likely to have CDI.
Key Words
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Article info
Publication history
Published online: December 16, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Declaration of Competing Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Identification
Copyright
© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
