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Clostridioides difficile Infection Is Associated with Adverse Outcomes among Hospitalized Pediatric Patients with Acute Pancreatitis

  • Thavamani, Aravind (Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine) ;
  • Umapathi, Krishna Kishore (Division of Pediatric Cardiology, Rush University Medical Center) ;
  • Khatana, Jasmine (Department of Pediatrics, MetroHealth Medical Center/Case Western Reserve University School of Medicine) ;
  • Sankararaman, Senthilkumar (Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine)
  • Received : 2021.05.24
  • Accepted : 2021.12.17
  • Published : 2022.01.15

Abstract

Purpose: Studies in adults have shown an increasing incidence of Clostridioides difficile infection (CDI) in patients hospitalized with acute pancreatitis (AP). There is lack of epidemiological data on CDI and its impact on hospitalized pediatric patients with AP. Methods: We analyzed the National Inpatient Sample and Kids' Inpatient Database between the years 2003 and 2016 and included all patients (age <21 years) with a primary diagnosis of AP using specific International Classification of Diseases codes. We compared clinical outcomes between children with CDI and those without CDI. Our primary outcome was severe AP and secondary outcomes included length of stay and hospital charges. Results: A total of 123,240 hospitalizations related to AP were analyzed and CDI was noted in 0.6% of the hospital. The prevalence rate of CDI doubled from 0.4% (2003) to 0.8% (2016), p=0.03. AP patients with CDI had increased comorbidities, and also underwent more invasive surgical procedures, p<0.05. AP patients with CDI had a higher in-hospital mortality rate and increased prevalence of severe AP, p<0.001. Multivariate regression models showed that CDI was associated with 2.4 times (confidence interval [CI]: 1.91 to 3.01, p<0.001) increased odds of severe AP. CDI patients had 7.24 (CI: 6.81 to 7.67, p<0.001) additional hospital days while incurring $59,032 (CI: 54,050 to 64,014, p<0.001) additional hospitalization charges. Conclusion: CDI in pediatric patients with AP is associated with adverse clinical outcomes and increased healthcare resource utilization. Further studies are needed to elucidate this association to prevent the development of CDI and to improve outcomes.

Keywords

References

  1. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143:1179-87.e3. https://doi.org/10.1053/j.gastro.2012.08.002
  2. Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology 2015;149:1731-41.e3. https://doi.org/10.1053/j.gastro.2015.08.045
  3. Deshpande A, Pant C, Anderson MP, Donskey CJ, Sferra TJ. Clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence. Pediatr Infect Dis J 2013;32:1138-40. https://doi.org/10.1097/INF.0b013e3182948518
  4. Nylund CM, Goudie A, Garza JM, Fairbrother G, Cohen MB. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med 2011;165:451-7. https://doi.org/10.1001/archpediatrics.2010.282
  5. Vaishnavi C, Gupta PK, Sharma M, Kochhar R. Pancreatic disease patients are at higher risk for Clostridium difficile infection compared to those with other co-morbidities. Gut Pathog 2019;11:17. https://doi.org/10.1186/s13099-019-0300-2
  6. Trikudanathan G, Munigala S. Impact of Clostridium difficile infection in patients hospitalized with acute pancreatitis- a population based cohort study. Pancreatology 2017;17:201-2. https://doi.org/10.1016/j.pan.2017.02.012
  7. Garg S, Pardi D, Khanna S. Clostridium difficile infection is associated with poor outcomes in acute pancreatitis: results from the Nationwide Inpatient Sample. Am J Gastroenterol 2016;111 Suppl:S99. https://doi.org/10.14309/00000434-201610001-00205
  8. Allegretti JR, Kadiyala V, Banks PA, McNabb-Baltar J. Risk factors for Clostridium difficile infections in patients hospitalized with acute pancreatitis. Am J Gastroenterol 2015;110 Suppl:S21.
  9. Maatman TK, Westfall-Snyder JA, Nicolas ME, Yee EJ, Ceppa EP, House MG, et al. The morbidity of C. difficile in necrotizing pancreatitis. Am J Surg 2020;219:509-12. https://doi.org/10.1016/j.amjsurg.2019.08.006
  10. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013;13(4 Suppl 2):e1-15. https://doi.org/10.1016/j.pan.2013.07.063
  11. Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, Bitton S, et al. Management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2018;66:159-76. https://doi.org/10.1097/MPG.0000000000001715
  12. Parniczky A, Lantos T, Toth EM, Szakacs Z, Godi S, Hagendorn R, et al. Antibiotic therapy in acute pancreatitis: from global overuse to evidence based recommendations. Pancreatology 2019;19:488-99. https://doi.org/10.1016/j.pan.2019.04.003
  13. Pant C, Deshpande A, Olyaee M, Anderson MP, Bitar A, Steele MI, et al. Epidemiology of acute pancreatitis in hospitalized children in the United States from 2000-2009. PLoS One 2014;9:e95552. https://doi.org/10.1371/journal.pone.0095552
  14. Abu-El-Haija M, El-Dika S, Hinton A, Conwell DL. Acute pancreatitis admission trends: a national estimate through the Kids' Inpatient Database. J Pediatr 2018;194:147-51.e1. https://doi.org/10.1016/j.jpeds.2017.09.061
  15. Thavamani A, Umapathi KK, Roy A, Krishna SG. The increasing prevalence and adverse impact of morbid obesity in paediatric acute pancreatitis. Pediatr Obes 2020;15:e12643.
  16. Abu-El-Haija M, Kumar S, Szabo F, Werlin S, Conwell D, Banks P, et al. Classification of acute pancreatitis in the pediatric population: clinical report from the NASPGHAN pancreas committee. J Pediatr Gastroenterol Nutr 2017;64:984-90. https://doi.org/10.1097/MPG.0000000000001583
  17. Wu LM, Sankaran SJ, Plank LD, Windsor JA, Petrov MS. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Br J Surg 2014;101:1644-56. https://doi.org/10.1002/bjs.9665
  18. Capurso G, Zerboni G, Signoretti M, Valente R, Stigliano S, Piciucchi M, et al. Role of the gut barrier in acute pancreatitis. J Clin Gastroenterol 2012;46 Suppl:S46-51. https://doi.org/10.1097/MCG.0b013e3182652096
  19. Baltatzis M, Mason JM, Chandrabalan V, Stathakis P, McIntyre B, Jegatheeswaran S, et al. Antibiotic use in acute pancreatitis: an audit of current practice in a tertiary centre. Pancreatology 2016;16:946-51. https://doi.org/10.1016/j.pan.2016.08.012
  20. Atassi H, Papachristou G, Hart PA, Lara LF, Kelly SG, Hinton A, et al. Su1461 adverse healthcare resource outcomes in patients with acute pancreatitis who develop Clostridium difficile infection during hospitalization. Gastroenterology 2020;158(6 Suppl 1):S-587-8.