CDI-Related Mortality Risk Greater in Hospitalized Children With Cystic Fibrosis

Hospitalized children with cystic fibrosis (CF) who develop coocuring Clostridioides difficile infection (CDI) are at significantly greater risk for adverse clinical outcomes, including death. Findings were published recently in Pediatric Pulmonology.

CDI is the most common pathogen causing health care–associated infection in the United States, in which incidence and number/severity of hospitalizations has been increasing in the adult population. Researchers noted that more recent reports, including nationwide studies, show CDI becoming an emerging problem in hospitalized children.

The occurrence of CDI in patients with CF is reported to be rare in adult and pediatric populations. Nonetheless, clinical outcomes for patients who develop these coocurring conditions have been shown to be significantly worse, including higher mortality, colectomy rates, length of stay (LOS), and hospital charges.

Moreover, despite these rare cases, adult patients with CF are at 3-fold greater risk of developing CDI compared with those without the condition.

“In children with CF, several risk factors for CDI colonization include frequent hospitalizations and exposure to a broad array of antibiotics,” noted the study authors. “Less is known about the impact of CDI on outcomes of pediatric CF hospitalizations.”

They conducted a cross-sectional analysis of data derived from the Kids’ Inpatient Database (KID) to compare the in-hospital mortality, LOS, and health care expenditure between pediatric CF hospitalizations with and without CDI, as well as to explore time trends in the proportion of CF hospitalizations with concomitant CDI between 1997 to 2016.

A total of 21,616 pediatric CF hospitalizations (median age, 13 years) were identified between 1997 and 2016, of which 240 (1.1%) hospitalizations with concurrent CDI diagnosis were identified. White patients and the South geographic region constituted the greatest proportion of CF hospitalizations in both groups, and private insurance composed the largest proportion of insurance overall (51%).

After adjusting for potential confounders, patients with concurrent CDI and CF were associated with a more than 5-fold risk of mortality (OR, 5.2; 95%, CI, 2.5-10.7), longer LOS (46.5% increment; 95% CI, 36.0%-57.1%), and higher charges (65.8% increment, 95% CI 53.5%-78.1%) for all comparisons compared with those without CDI. The proportion of CF hospitalizations with CDI increased over time, from 0.64% in 1997 to 1.73% in 2016 (P < .001).

The lack of data on the onset of CDI relative to the CF hospitalization and cause of death were cited as limitations, and the researchers added there is a need for caution surrounding conclusions regarding causality.

Nonetheless, the study authors said these findings highlight the need for further exploration of health outcomes among pediatric patients with comorbid CF and CDI. They also noted that outcomes may be modified by use of modulator therapies such as elexacaftor/tezacaftor/ivacaftor, given its potential for clinically relevant and actionable implications for multidisciplinary care for children with CF.

Reference

Santhanam P, Egberg M, Kappelman MD. Higher mortality rates associated with Clostridioides difficile infection in hospitalized children with cystic fibrosis. Pediatr Pulmonol. Published online November 9, 2022. doi:10.1002/ppul.26214