Depression, antidepressant medications, and risk of Clostridium difficileinfection

Abstract

BackgroundAn ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.MethodsIn Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.ResultsThe population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.ConclusionsAdults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

The Association between GABA-Modulators and Clostridium difficile Infection – A Matched Retrospective Case-Control Study

“…When patients with a recent history of depression were excluded from the analysis, regular zolpidem use was identified as a statistically significant risk factor for CDI; whereas zolpidem use had no effect on individuals diagnosed with depression. In our study, history of depression was associated with controls, contrary to findings from a prior study [13]. The finding is interesting, but it should be noted that even though careful assessment of variables was performed, history of depression is a factor prone to non-differential misclassification.…”

The Association between GABA-Modulators and Clostridium difficile Infection – A Matched Retrospective Case-Control Study

“…When patients with a recent history of depression were excluded from the analysis, regular zolpidem use was identified as a statistically significant risk factor for CDI; whereas zolpidem use had no effect on individuals diagnosed with depression. In our study, history of depression was associated with controls, contrary to findings from a prior study [13]. The finding is interesting, but it should be noted that even though careful assessment of variables was performed, history of depression is a factor prone to non-differential misclassification.…”

Antidepressant Medications Are Associated With Increased Risk of Hospital-Acquired Clostridioides Difficile Infection: A Population-Based Study

“…Using multivariate regression analysis, specific types of antidepressant medications were also associated with a higher risk of CDI including mirtazapine, fluoxetine, nortriptyline, amitriptyline, trazodone, and duloxetine. Results of our study for mirtazapine, nortriptyline, and trazodone are comparable to the ones of Rogers et al (2) . Regarding fluoxetine, the risk of developing CDI was increased in univariate regression analysis (OR: 1.90; 95%CI: 1.86-1.94).…”

Identification of target risk groups for population-based Clostridium difficile infection prevention strategies using a population attributable risk approach

“…In addition, one report recommended that all patients hospitalized with an IBD flare-up should undergo testing for CDI (Surawicz et al, 2013). Our study also identified depression as a significant risk factor for CDI with an OR of 1.45, consistent with a previous study (Rogers et al, 2013).…”

The Association between GABA-Modulators and Clostridium difficile Infection – A Matched Retrospective Case-Control Study

“…When patients with a recent history of depression were excluded from the analysis, regular zolpidem use was identified as a statistically significant risk factor for CDI; whereas zolpidem use had no effect on individuals diagnosed with depression. In our study, history of depression was associated with controls, contrary to findings from a prior study [13]. The finding is interesting, but it should be noted that even though careful assessment of variables was performed, history of depression is a factor prone to non-differential misclassification.…”

Antidepressant Medications Are Associated With Increased Risk of Hospital-Acquired Clostridioides Difficile Infection: A Population-Based Study

“…Using multivariate regression analysis, specific types of antidepressant medications were also associated with a higher risk of CDI including mirtazapine, fluoxetine, nortriptyline, amitriptyline, trazodone, and duloxetine. Results of our study for mirtazapine, nortriptyline, and trazodone are comparable to the ones of Rogers et al (2) . Regarding fluoxetine, the risk of developing CDI was increased in univariate regression analysis (OR: 1.90; 95%CI: 1.86-1.94).…”

Identification of target risk groups for population-based Clostridium difficile infection prevention strategies using a population attributable risk approach

“…In addition, one report recommended that all patients hospitalized with an IBD flare-up should undergo testing for CDI (Surawicz et al, 2013). Our study also identified depression as a significant risk factor for CDI with an OR of 1.45, consistent with a previous study (Rogers et al, 2013).…”

The Association between GABA-Modulators and Clostridium difficile Infection – A Matched Retrospective Case-Control Study

“…When patients with a recent history of depression were excluded from the analysis, regular zolpidem use was identified as a statistically significant risk factor for CDI; whereas zolpidem use had no effect on individuals diagnosed with depression. In our study, history of depression was associated with controls, contrary to findings from a prior study [13]. The finding is interesting, but it should be noted that even though careful assessment of variables was performed, history of depression is a factor prone to non-differential misclassification.…”

Antidepressant Medications Are Associated With Increased Risk of Hospital-Acquired Clostridioides Difficile Infection: A Population-Based Study

“…Using multivariate regression analysis, specific types of antidepressant medications were also associated with a higher risk of CDI including mirtazapine, fluoxetine, nortriptyline, amitriptyline, trazodone, and duloxetine. Results of our study for mirtazapine, nortriptyline, and trazodone are comparable to the ones of Rogers et al (2) . Regarding fluoxetine, the risk of developing CDI was increased in univariate regression analysis (OR: 1.90; 95%CI: 1.86-1.94).…”

Identification of target risk groups for population-based Clostridium difficile infection prevention strategies using a population attributable risk approach

“…In addition, one report recommended that all patients hospitalized with an IBD flare-up should undergo testing for CDI (Surawicz et al, 2013). Our study also identified depression as a significant risk factor for CDI with an OR of 1.45, consistent with a previous study (Rogers et al, 2013).…”