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Background As rates of pediatric community-associated (CA) Clostridium difficile infection (CDI) increase, additional research is needed to address rates of infection following common antibiotics. Methods This study was a retrospective review of the electronic health records of all children with stool specimens sent for C difficile from January first 2012 – December 31st2016 at Kaiser Permanente Northern California. Children with clinical symptoms consistent with CDI, confirmatory laboratory testing, no other identified causes of diarrhea, and community associated disease were defined as cases. Using outpatient and ED antibiotic prescription records for children, incidence rates were calculated for subsequent CA CDI for the most commonly prescribed antibiotics. Results Of 507 primary CDI cases in our cohort, 327 had any antibiotic use 2012–2015. There were 205 primary CDI cases that were preceded by an antibiotic in the previous 1–365 days. Many of these patients had more than 1 antibiotic in the preceding year. Of those, rates of CA CDI were uncommon following common antibiotics. (Table) The highest rate of CA CDI followed ceftriaxone, cefdinir, ciprofloxacin and augmentin. The lowest rates were seen following penicillin, doxycycline and azithromycin. Ninety-three percent of the antibiotic prescriptions were in outpatients, 7% in inpatients. Table: Incidence rate of CA CDI following common antibiotics Drug # Rx CA CDI cases with at least 1 prescription in last year Rate Rate per 100,000 Amoxicillin 86,180 38 0.0004 44 Augmentin 49,361 35 0.0007 71 Azithromycin 160,846 45 0.0003 28 Cefdinir 37,284 36 0.0010 97 Ceftriaxone 10,616 11 0.0010 104 Cefuroxime 852 1 0.0012 117 Cephalexin 124,293 55 0.0004 44 Ciprofloxacin 10,088 9 0.0009 89 Clindamycin 79,884 36 0.0005 45 Doxycycline 37,086 8 0.0002 22 Levofloxacin 687 1 0.0015 146 Penicillin 19,488 4 0.0002 21 Rifampin 486 0 0 0 Sulfamethoxazole TMP 49,918 34 0.0007 68 Tetracycline 6 0 0 0 Total 667,075 205 0.0003 31 Conclusion As rates of CA CDI increase, clinicians should be aware of rates of infection following administration of common antibiotics. The most common antibiotics to cause CA CDI were third-generation cephalosporins (ceftriaxone and cefdinir) and ciprofloxacin. Disclosures All authors: No reported disclosures.

Incidence of Pediatric Community Associated Clostridium Difficile Infection Following Common Antibotics