Year, Volume, Issue, Page(s):16, 159, 6, 1631-1637
Study investigated the effect of Clostridium difficile-associated diarrhea (CDAD) on morbidity and mortality in severely burned children and identified CDAD risk factors. After retrospective review of 2,840 records, 288 pediatric burn patients were identified as having diarrhea, defined as stool output of more than 10 milliliters per kilogram per day for 2 or more successive days) and had stool samples immunoassayed for toxins A and B. A case-control analysis was performed by matching cases to controls via logistic regression and propensity scores so that age, admission time, and time of occurrence could be controlled; the outcomes of interest were mortality and hospitalization time. Eighteen patients tested positive for C difficile toxins (median age, 4 years; mean total body surface area burned, 59 percent). In the CDAD group, unadjusted in-hospital mortality was 28 percent. Hospitalization averaged 48 days in the CDAD group and 38 days in the non-CDAD group. Duration of stay per percent of total body surface area burned was greater in the CDAD group (0.82 versus 0.60), as were prolonged bouts of diarrhea complicated by acidosis (13 versus 4 days). Of the 18 possible risk factors evaluated, inhalation injury diagnosed at admission occurred more often in CDAD patients than matched controls (59 versus 31 percent). The findings indicate that CDAD during hospitalization is associated with greater mortality after burns. Inhalation injury increases the likelihood of C difficile infection. Whether C difficile infection is an indication of greater illness among certain burned patients is unknown.