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Scientific Oral Presentations

Care Equity, Quality, and Safety

Session: Scientific Oral Presentation 3 - Care Equity, Quality and Safety

Clostridioides difficile Infection Risk in Children Prescribed Antibiotics for Tonsillectomy

Monday, October 13, 2025

9:30 AM - 9:36 AM EDT

Location: 107-108

Disclosure(s):

Erin M. Gawel, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Deepthi S. Akella, DO, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nicole M. Favre, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The American Academy of Otolaryngology-Head and Neck Surgery advises against the use of antibiotics in children undergoing tonsillectomy. This study assessed whether antibiotic use in this setting is associated with an increased risk of Clostridioides difficile (C. diff) infection, a potentially serious healthcare-associated complication.

Methods: A retrospective cohort study was conducted using the US Network in TriNetX, a global EHR database. Patients under 18 years of age 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 formed: patients who received antibiotics within 7 days of surgery and those who did not. Antibiotic use was identified using VA drug class codes for penicillins and beta-lactams (AM114), tetracyclines (AM250), lincomycins (AM350), or erythromycins and macrolides (AM200). Propensity score matching was applied for sex, race, and age. C. diff prevalence within 90 days was assessed using ICD-10 code A04.7.

Results: Between 2006 and 2024, antibiotics were prescribed to 16.4% (N = 58913/360158) of children undergoing tonsillectomy. Propensity score matching resulted in 58722 patients in each cohort, with a mean age of 6.7 years (SD = 4.1). The most common antibiotic prescribed was amoxicillin (N = 37217, 63.4%) followed by cefazolin (N = 10226, 17.4%) and ampicillin (N = 6716, 11.4%). The prevalence of C. diff was significantly higher in the antibiotic group (N = 42, 0.07%) compared to the non-antibiotic group (N = 10, 0.02%, p<.0001). Despite the low overall risk of C. diff in both groups, children who received antibiotics had a fourfold increased risk of developing C. diff infection (RR = 4.2, 95% CI: 2.1-8.4, p<.001).

Conclusions: Despite guidelines advising against routine antibiotic use in tonsillectomy, many children still receive them, which is associated with an increased risk of C. diff infection. These findings emphasize the importance of antibiotic stewardship in reducing preventable complications and improving overall healthcare quality.

Presenting Author(s)

Erin M. Gawel, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

GV

Gaayathri Varavenkataraman, MA

Research Assistant
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
East Amherst, New York, United States

Disclosure information not submitted.
Deepthi S. Akella, DO, MS

Resident Physician
University of Missouri Department of Otolaryngology
Columbia, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Nicole M. Favre, MD

Resident Physician
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Luke J. Reardon, BS

Medical Student
Lincoln Memorial University DeBusk College of Osteopathic Medicine
Scottsdale, AZ, United States

Disclosure information not submitted.

Senior Author(s)

MC

Michele M. Carr, DDS MD PhD

Professor
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Williamsville, New York, United States

Disclosure information not submitted.