Vancomycin Use for Pediatric Clostridium difficile Infection is Increasing and Associated with Specific Patient Characteristics.
Antimicrob Agents Chemother. 2013 Jun 24;
Authors: Schwenk HT, Graham DA, Sharma TS, Sandora TJ
In adults with C. difficile infection (CDI), enteral vancomycin is considered the preferred initial regimen for severe disease; however, patterns of antimicrobial use for children with CDI are unknown. We sought to describe trends in and predictors of vancomycin use for the treatment of children with CDI admitted to tertiary care children's hospitals in the United States. We used a database of freestanding children's hospitals to identify patients 1-18 years old with CDI between 01/2006-06/2011. The first hospitalization with a diagnosis of CDI for each patient was identified and CDI-directed therapy was assessed. Generalized estimating equations were used to identify predictors of vancomycin receipt, controlling for clustering within hospitals. Vancomycin use has increased significantly (P=0.005), with substantial variability between hospitals (0-16%). In multivariate analyses, vancomycin use was more common in children age 7-13 years (vs. 1-2 years, adjusted odds ratio [AOR] 1.57; 95% confidence interval [CI] 1.13-2.18), 14-18 years (AOR 1.40; CI 1.11-1.76), in an ICU (AOR 1.37; CI 1.05-1.80), and with chronic gastrointestinal conditions (AOR 2.01; CI 1.44-2.81). Vancomycin use was less common in black (AOR 0.53; CI 0.39-0.73) and Hispanic (AOR 0.63; CI 0.47-0.84) patients, and children with malignancies (AOR 0.57; CI 0.36-0.89). Despite a lack of empirical evidence to suggest superiority, vancomycin use for pediatric CDI is increasing. Furthermore, there is substantial variability in vancomycin use between hospitals. Further studies are needed to explore potential racial and ethnic differences in CDI management and to investigate clinicians' rationale for using vancomycin for initial therapy in selected populations.
PMID: 23796942 [PubMed - as supplied by publisher]