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Impact of Clostridium difficile infection on pediatric appendicitis



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.


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.


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.


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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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.

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Correspondence to Pavan Brahmamdam.

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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).

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  • Clostridium difficile
  • Appendicitis
  • Antibiotics
  • Stewardship