Summary
Introduction
Clostridium difficile infections (CDIs) are rising among pediatric patients in the community and hospital
setting. Children undergoing transplants and bowel surgery are at a higher risk, while
renal surgery has a lower risk. We hypothesize children undergoing pediatric urologic
procedures are uncommonly diagnosed with postoperative CDI.
Objective
To study CDI in pediatric patients undergoing urologic surgery and identify associated
perioperative factors.
Study design
The American College of Surgeons National Surgical Quality Improvement Program Pediatric
data file was queried for children undergoing surgery with pediatric urology or urology
between 2015 and 2017. Data points included patient demographics (age, gender, race,
ASA classification), surgery performed, and perioperative outcomes (operative time,
admission status, length of stay, complications, readmission, and reoperation). Students
T-test and Chi-square analyses were applied to detect differences between those with
CDI and those without CDI.
Results
Of the 27,193 patients undergoing urologic surgery, 36 (0.13%) were diagnosed with
CDI. The surgeries are presented in the Summary Figure. Patients with CDI were more
likely to be female (50% vs 28%, p = 0.003) than those without. There was no difference
in mean age or race. Children with CDI had higher ASA classifications (p < 0.001).
Their mean operative times were longer (156.1 ± 19.6 vs 105.2 ± 0.6 min, p < 0.001),
as were their mean lengths of stay (4.6 ± 0.8 vs 1.3 ± 0.0 days, p < 0.001). CDI patients
were more likely to have other complications (29% vs 6%, p < 0.001). Among patients
with CDI, 19.4% experienced concomitant infectious complications. There was no difference
in reoperation rate, but more patients with CDI required readmission (56% vs 4%, p < 0.001).
A third of children with CDI had undergone vesicoureteral reflux correction, comprising
0.3% of the included procedures. Over 11% of children with CDI had undergone nephrectomy,
comprising 1.1% of the included procedures for the highest rate.
Discussion
CDI are uncommon following pediatric urologic procedures. No patients undergoing inguinal
or scrotal cases developed CDI, while only one patient developed CDI after penile
surgery. Our study does have several important limitations: we are unable to provide
clinical information about the exact diagnoses, CDI risk factors such as antibiotic
usage or comorbid conditions, and the number of patients who were tested for CDI.
Conclusion
Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cost-utility analysis of antimicrobial stewardship programme at a tertiary teaching hospital in Ethiopia.BMJ Open. 2021; 11e047515https://doi.org/10.1136/bmjopen-2020-047515
- Core elements of hospital antibiotic stewardship programs.US Department of Health and Human Services, CDC, Atlanta, GA2019 (Available at:)https://www.cdc.gov/antibiotic-use/core-elements/hospital.htmlDate accessed: February 14, 2022
- The epidemiology of Clostridium difficile infection in children: a population-based study.Clin Infect Dis. 2013; 56: 1401-1406https://doi.org/10.1093/cid/cit075
- Costs of Clostridium difficile infection in pediatric operations: a propensity score-matching analysis.Surgery. 2017; 161: 1376-1386https://doi.org/10.1016/j.surg.2016.10.020
- Attributable cost of Clostridium difficile infection in pediatric patients.Infect Control Hosp Epidemiol. 2017; 38: 1472-1477https://doi.org/10.1017/ice.2017.240
American College of Surgeons National Surgical Quality Improvement Program Pediatric. https://www.facs.org/quality-programs/childrens-surgery/pediatric/overview. [Accessed on 2/3/2022]
- Epidemiology and risk factors for Clostridium difficile infection in children.Pediatr Infect Dis J. 2011; 30: 580-584https://doi.org/10.1097/INF.0b013e31820bfb29
- Pediatric nephrectomy: incidence, indications and use of minimally invasive techniques.J Urol. 2014; 191: 764-770https://doi.org/10.1016/j.juro.2013.09.063
- Clostridium difficile infection among children with cancer.Pediatr Infect Dis J. 2011; 30: 610-612https://doi.org/10.1097/INF.0b013e31820970d1
- National practice patterns and outcomes of pediatric nephrectomy: comparison between urology and general surgery.J Urol. 2015; 193: 1737-1741https://doi.org/10.1016/j.juro.2014.10.116
- Surgical antibiotic practices among pediatric urologists in the United States.J Pediatr Urol. 2011; 7: 192-197https://doi.org/10.1016/j.jpurol.2010.05.001
- Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the infectious diseases Society of America (IDSA) and Society for healthcare epidemiology of America (SHEA).Clin Infect Dis. 2018; 66: 987-994https://doi.org/10.1093/cid/ciy149
- Prevalence of detection of clostridioides difficile among asymptomatic children: a systematic review and meta-analysis.JAMA Pediatr. 2021; 175e212328https://doi.org/10.1001/jamapediatrics.2021.2328
- Treatment of Clostridium difficile infection in pediatric patients.Expet Rev Gastroenterol Hepatol. 2015; 9: 747-755https://doi.org/10.1586/17474124.2015.1039988
- Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children.Cochrane Database Syst Rev. 2017; 12: CD006095https://doi.org/10.1002/14651858.CD006095.pub4
- Clostridium difficile infection in hospitalized children in the United States.Arch Pediatr Adolesc Med. 2011; 165: 451-457https://doi.org/10.1001/archpediatrics.2010.282
- Risk factors for community-associated Clostridium difficile infection in children.J Pediatr. 2017; 186: 105-109https://doi.org/10.1016/j.jpeds.2017.03.032
- The use of postoperative prophylactic antibiotics in stented distal hypospadias repair: a systematic review and meta-analysis.J Pediatr Urol. 2019; 15: 138-148https://doi.org/10.1016/j.jpurol.2018.10.012
- Is surgical antibiotic prophylaxis necessary for pediatric orchiopexy?.J Pediatr Urol. 2018; 14: 261.e1-261.e7https://doi.org/10.1016/j.jpurol.2018.01.019
Article info
Publication history
Published online: September 02, 2022
Accepted:
August 27,
2022
Received in revised form:
July 6,
2022
Received:
February 15,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
