Abstract
Background
As rates of pediatric community-associated (CA) Clostridium difficile infection (CDI) increase, additional research is needed to address rates of infection following common antibiotics.
Methods
This study was a retrospective review of the electronic health records of all children with stool specimens sent for C difficile from January first 2012 – December 31st2016 at Kaiser Permanente Northern California. Children with clinical symptoms consistent with CDI, confirmatory laboratory testing, no other identified causes of diarrhea, and community associated disease were defined as cases. Using outpatient and ED antibiotic prescription records for children, incidence rates were calculated for subsequent CA CDI for the most commonly prescribed antibiotics.
Results
Of 507 primary CDI cases in our cohort, 327 had any antibiotic use 2012–2015. There were 205 primary CDI cases that were preceded by an antibiotic in the previous 1–365 days. Many of these patients had more than 1 antibiotic in the preceding year.
Of those, rates of CA CDI were uncommon following common antibiotics. (Table) The highest rate of CA CDI followed ceftriaxone, cefdinir, ciprofloxacin and augmentin. The lowest rates were seen following penicillin, doxycycline and azithromycin. Ninety-three percent of the antibiotic prescriptions were in outpatients, 7% in inpatients.
Table: Incidence rate of CA CDI following common antibiotics
| Drug | # Rx | CA CDI cases with at least 1 prescription in last year | Rate | Rate per 100,000 |
|---|---|---|---|---|
| Amoxicillin | 86,180 | 38 | 0.0004 | 44 |
| Augmentin | 49,361 | 35 | 0.0007 | 71 |
| Azithromycin | 160,846 | 45 | 0.0003 | 28 |
| Cefdinir | 37,284 | 36 | 0.0010 | 97 |
| Ceftriaxone | 10,616 | 11 | 0.0010 | 104 |
| Cefuroxime | 852 | 1 | 0.0012 | 117 |
| Cephalexin | 124,293 | 55 | 0.0004 | 44 |
| Ciprofloxacin | 10,088 | 9 | 0.0009 | 89 |
| Clindamycin | 79,884 | 36 | 0.0005 | 45 |
| Doxycycline | 37,086 | 8 | 0.0002 | 22 |
| Levofloxacin | 687 | 1 | 0.0015 | 146 |
| Penicillin | 19,488 | 4 | 0.0002 | 21 |
| Rifampin | 486 | 0 | 0 | 0 |
| Sulfamethoxazole TMP | 49,918 | 34 | 0.0007 | 68 |
| Tetracycline | 6 | 0 | 0 | 0 |
| Total | 667,075 | 205 | 0.0003 | 31 |
Conclusion
As rates of CA CDI increase, clinicians should be aware of rates of infection following administration of common antibiotics. The most common antibiotics to cause CA CDI were third-generation cephalosporins (ceftriaxone and cefdinir) and ciprofloxacin.
Disclosures
All authors: No reported disclosures.