This cohort study uses electronic health records across 3 diverse pediatric health care networks to characterize the incidence, recognition, and distinguishing clinical features of pediatric C difficile infection–associated reactive arthritis among children with C difficile infection.
This study assesses national variability and appropriateness of antibiotic prophylaxis among US pediatric surgical patients.
Antimicrobial stewardship (AS) can prevent emergence of antibiotic resistance while improving patient outcomes and safety. Hyun et al review the literature for strategies to implement AS programs and identify barriers and challenges.
To evaluate the trend in Clostridium difficile infection (CDI) among hospitalized children in the United States and to evaluate the severity of and risk factors associated with these cases of CDI.
A retrospective cohort study using the triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 1997, 2000, 2003, and 2006.
Hospitalized children in the United States.
A nationally weighted number of patients (10 474 454) discharged from the hospital, 21 274 of whom had CDI.
Discharge diagnosis of CDI.
Trend in cases of CDI; effect and severity were measured by length of hospital stay, hospitalization charges, colectomy rate, and death rate.
There was an increasing trend in cases of CDI, from 3565 cases in 1997 to 7779 cases in 2006 (P < .001). Patients with CDI had an increased risk of death (adjusted odds ratio [OR], 1.20; 95% confidence interval [95% CI], 1.01-1.43), colectomy (adjusted OR, 1.36; 95% CI, 1.04-1.79), a longer length of hospital stay (adjusted OR, 4.34; 95% CI, 3.97-4.83), and higher hospitalization charges (adjusted OR, 2.12; 95% CI, 1.98-2.26). There was no trend in death, colectomy, length of hospital stay, or hospitalization charges during the 4 time periods (ie, 1997, 2000, 2003, and 2006). The risk of comorbid diagnoses associated with CDI included inflammatory bowel disease, with an OR of 11.42 (95% CI, 10.16-12.83), and other comorbid diagnoses associated with immunosuppression or antibiotic administration.
There is an increasing trend in CDI among hospitalized children, and this disease is having a significant effect on these children. In contrast to adults, there is no increasing trend in the severity of CDI in children. Children with medical conditions (including inflammatory bowel disease and immunosuppression) or conditions requiring antibiotic administration are at high risk of CDI.
Kaufman and colleagues determine if nonsterile glove use after hand hygiene before all patient and venous catheter contact, compared with hand hygiene alone, prevents late-onset infections in preterm infants. See also the editorial by Coffin.
Rosen and colleagues determine if acid suppression use results in gastric bacterial overgrowth, if there are changes in lung microflora associated with the use of gastric bacterial overgrowth, and if changes in lung microflora are related to full-column nonacid gastroesophageal reflux.
This Viewpoint discusses the importance of discharge stewardship within antimicrobial stewardship programs.
This review examines the pathogenesis, epidemiologic features, diagnosis, and management of inflammatory bowel disease in children and adolescents.
This retrospective cohort study suggests that clinicians reconsider the practice of treating otherwise healthy children with acute osteomyelitis with prolonged intravenous antibiotics when an equally effective oral alternative exists.
Berry and colleagues discuss the lack of pediatric standards for hospital discharge and provide a framework to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. Apkon and Friedman as well as Faultner provided related editorials.