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C. diff on Rise in Kids -- and Outside Hospital

Study Shows Cases of Dangerous Diarrhea Bug Increased 12-Fold Among Children
WebMD Health News
Reviewed by Louise Chang, MD

May 21, 2012 -- The potentially deadly diarrhea bug Clostridium difficile, or C. diff, is spreading among children in the community, a new study shows.

"The typical person with C. difficile is thought of as being older, taking antibiotics, and in the hospital. For the first time, we are describing a substantial rise in new cases in children outside the hospital," says researcher Sahil Khanna, MBBS, a gastroenterologist at the Mayo Clinic in Rochester, Minn.

"Our most striking observation is that three-quarters of cases in children are being contracted in the community, not in the hospital," he tells WebMD. "That's huge compared to the past."

Based on the findings, parents whose child comes down with persistent diarrhea may want to consult a doctor to make sure it's not C. diff, he says.

Khanna presented the study today at Digestive Disease Week 2012 in San Diego.

Diarrhea Is Cardinal Symptom

C. diff are bacteria that produce toxins that damage the lining of the gut. There are about 337,000 hospital stays due to C. diff infection reported each year, resulting in 14,000 deaths, according to the CDC.

Common symptoms of a mild infection include watery diarrhea two or more times a day for two or more days and mild abdominal cramping and tenderness. In severe cases, the bug can lead to inflammation of the colon, resulting in fever, blood, or pus in the stool, nausea, dehydration, loss of appetite, and substantial weight loss.

For the study, researchers examined the medical records of people in Olmsted County, Minn., to identify children and teens 18 and under with C. diff infections from 1991-2009. The county's records are ideal for such a study, as every person seen in any health care facility or who fills a prescription is tracked, Khanna says.

A total of 92 children, whose average age was about 2 years, were identified. Nearly half were babies less than a year old.

Other findings:

  • The number of infections in children was more than 12 times higher in the 2004-2009 time period, compared to the 1991-1997 time period (32.6 cases per 100,000 vs. 2.6 cases per 100,000).
  • A total of 75% of cases were "community-acquired," meaning that the patients had not been recently hospitalized prior to contracting C. diff.
  • Nine percent of cases were severe, and 1% died; 20% developed recurrent infections.
  • A total of 76% of cases occurred in children that had recently been prescribed antibiotics, which can kill "good" bacteria in the gut that keep C. diff at bay. Also, 20% had taken stomach acid-reducing drugs linked to risk for C. diff infection.

David Bernstein, MD, a gastroenterologist at North Shore University Hospital in Manhasset, N.Y., tells WebMD the findings are concerning.

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