Clostridioides difficile Infection Risk in Children Prescribed Antibiotics for Tonsillectomy.

Abstract

To evaluate whether antibiotic use in pediatric patients undergoing tonsillectomy is associated with an increased risk of Clostridioides difficile infection (CDI). Retrospective cohort study. US Network in TriNetX. Patients younger than 18 years who underwent tonsillectomy between 2006 and 2024 were identified using CPT codes 42820, 42821, 42825, or 42826, SNOMED codes 173422009 or 28913000, or ICD-10-PCS code 0CTP. Two cohorts were created based on whether antibiotics were prescribed within 7 days of surgery. Antibiotic use was identified through medication records. Propensity score matching was applied for age, sex, and race. CDI within 90 days was identified using ICD-10 code A04.7. Between 2006 and 2024, antibiotics were prescribed to 16.5% (N = 58,845/356,950) of children undergoing tonsillectomy. After matching, each cohort included 58,722 patients (mean age 6.7 ± 4.1 years). The most common antibiotic prescribed was amoxicillin (N = 37,217, 63.4%), followed by cefazolin (N = 10,226, 17.4%). The prevalence of CDI was significantly higher in the antibiotic group (N = 42, 0.07%) compared to the nonantibiotic group (N = 10, 0.02%, P < .0001). Antibiotic exposure was associated with a fourfold increased risk of CDI (risk ratio [RR] = 4.2, 95% CI: 2.1-8.4, P < .001). Despite recommendations against routine antibiotic use in tonsillectomy, a substantial proportion of children receive them. This practice is linked to an elevated risk of CDI, emphasizing the importance of antibiotic stewardship in surgical care.