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Impact of Clostridium difficile infection on pediatric appendicitis

Abstract

Introduction

Clostridium difficile is an important cause of nosocomial infection in the pediatric population. The purpose of this study is to estimate the impact of Clostridium difficile infection complicating pediatric acute appendicitis.

Methods

This study utilizes the combined 2009 and 2012 Kids’ Inpatient Database. Statistical analysis is weighted and was done using Survey Sampling and Analysis procedures in SAS 9.4.

Results

We identified 176,934 cases with appendicitis and 0.2% (n = 358) had a concurrent diagnosis of C. difficile. The proportion of cases with C. difficile in perforated appendicitis was greater than in the non-perforated cases (0.39% vs. 0.06%; p < .01). Multivariate analysis showed that perforated appendicitis (OR 5.22), and anemia (OR 4.95) were independent predictors of C. difficile infection (p < .001). Adjusted for perforated appendicitis, cases with C. difficile had 4.78 days longer length of stay (LOS) and higher total charges of $29,887 (all p < 0.0001) compared to non-C. difficile cases.

Conclusion

C. difficile infection is a rare, but impactful complication of pediatric appendicitis and is associated with greater disease severity. Proper antibiotic stewardship could minimize the risk of C. difficile in pediatric appendicitis.

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Acknowledgements

Our sincere gratitude to the entire staff at the Oakland University William Beaumont school of medicine, and the section of Pediatric Surgery at Beaumont Health for their support through this project.

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All authors contributed equally to the study design, analysis and discussion.

Corresponding author

Correspondence to Pavan Brahmamdam.

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The authors declare that they have no conflict of interest.

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No informed consent was required for this study.

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Orelaru, F., Karabon, P., Novotny, N. et al. Impact of Clostridium difficile infection on pediatric appendicitis. Pediatr Surg Int 37, 865–870 (2021). https://doi.org/10.1007/s00383-021-04893-3

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Keywords

  • Clostridium difficile
  • Appendicitis
  • Antibiotics
  • Stewardship