Antacids May Increase Some Children's Risk of C. diff Infection
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SAN DIEGO—Acid suppression in children with comorbidities was associated with increased risk of Clostridium difficile infections (CDIs), according to a retrospective study presented at IDWeek 2017.
“Exposure to antimicrobial and antacid agents was associated with an increased risk of developing a community-acquired CDI when evaluated with comorbidities and inpatient status,” reported lead study author Hoang A. Huynh, PharmD, MBA, and colleagues, from the Department of Pharmacy Practice, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, in Little Rock, AR.
“Antimicrobial exposure was associated with an increased risk for hospitalization due to a CDI. Exposure to acid suppression agents in patients with comorbidities was associated with an increased risk for a CDI," said Huynh. CDI risk was not modulated by age or gender.
“As pediatric outpatient antimicrobial stewardship evolves, improving CDI rates can center on improving antimicrobial and acid suppressive agent usage,” Dr. Huynh and coauthors reported in a poster presentation.
CDI increases children's risk of severe diarrhea and can be life-threatening, they reported. But whereas the epidemiological risk factors for CDI among adults are well known, data is “limited” for children, Dr. Huynh noted. The authors therefore sought to assess a suspected association between antacid and CDIs in children aged 1 to 18 years treated between November 2013 and October 2016 at Arkansas Children's Hospital. Children were determined to be C. difficile-infected if they tested PCR positive and experienced ≥3 loose stools.
Children for whom PCR had been positive within 60 days were not included in the study.
“A total of 139 cases of CDI among 123 patients were evaluated,” Dr. Huynh reported. (Eleven of the 139 patients experienced hospital-onset CDI; the other 128 had community-onset CDIs.)
Pediatric risk factors for CDI included exposure to acid suppressing agents and antimicrobials, particularly among children with ≥1 comorbidities. “Cases having ≥1 comorbidities were found to be associated with previous antacid exposure (P<0.0005),” Dr. Huynh noted. There was no difference seen between the use of a proton pump inhibitor (PPI) or an H2 receptor antagonist (H2RA) with developing CDIs.
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Huynh HA, Wisdom C, Maples HD. Association of acid suppression and antibicrobial use with Clostridium difficle infection in children. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org.