Recurrent Clostridium difficile infection in intensive care unit patients

Jasiak, Natalia M.; Alaniz, Cesar; Rao, Krishna; Veltman, Katherine; Nagel, Jerod

doi:10.1016/j.ajic.2015.08.013

Cited by 12 publications

(9 citation statements)

References 12 publications

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“…Similarly, Tariq et al conducted a meta-analysis of observational studies that showed gastric acid suppression may increase the risk of recurrent CDI [18]. Moreover, hospitalization in the ICU was not found to be significantly associated with a higher risk of recurrent CDI in our study, contrary to a study performed by Jasiak and colleagues who found that adults hospitalized in the ICU had a significantly higher incidence of recurrent CDI compared to non-ICU patients [19].…”

Section: Discussioncontrasting

confidence: 95%

Risk Factors Associated With Recurrent Clostridium difficile Infection

et al. 2019

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BackgroundRecurrence of Clostridium difficile infection (CDI) is a problem that can cost up to $20,000 each year in the United States. Studies have reported risk factors that may be associated with a higher incidence of recurrent CDI. We studied additional risk factors, including history of partial colectomy, chemotherapy use and hospitalization in the intensive care unit (ICU).MethodsWe conducted a retrospective chart review of all outpatients and inpatients at our institution to determine risk factors associated with recurrent CDI. Frequencies were compared using Fisher’s exact test and continuous data were compared using Wilcoxon ranks sums test. Recurrent CDI was determined for all patients and risk factors were analyzed using single and multiple logistic regression. A P < 0.05 was used to determine significance.ResultsThis study included 435 patients and found that advanced age significantly increased the odds of recurrent CDI by 2.3% per year (OR = 1.023, 95% CI = 1.009 - 1.037, P < 0.05). Patients with prior partial colectomy were found to have 3.2 times increased odds of recurrence compared to those without history of partial colectomy (OR = 3.168, 95% CI = 1.324 - 7.579, P < 0.05). Patients receiving chemotherapy or hospitalized in the ICU were not found to have a significantly higher rate of recurrent CDI (P > 0.05).ConclusionsAdvanced age and history of partial colectomy were associated with a significantly higher recurrence rate of CDI. Contrary to prior studies, chemotherapy use or hospitalization in the ICU were not found to be associated with a higher rate of recurrent CDI.

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Section: Discussioncontrasting

confidence: 95%

Risk Factors Associated With Recurrent Clostridium difficile Infection

et al. 2019

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“…A possible explanation for this could be that the increased susceptibility to bacterial respiratory tract infections in COPD patients contributes to greater consumption of antibiotics, which in turn predisposes patients to HO-CDI [18]. According to Jasiak et al, COPD resulted in a 3.5-fold increased risk of recurrent HO-CDI [19].…”

Section: Discussionmentioning

confidence: 99%

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

Mutai

Mureithi

Anzala

et al. 2022

PLOS Glob Public Health

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Introduction Clostridioides difficile is primarily associated with hospital-acquired diarrhoea. The disease burden is aggravated in patients with comorbidities due to increased likelihood of polypharmacy, extended hospital stays and compromised immunity. The study aimed to investigate comorbidity predictors of healthcare facility-onset C. difficile infection (HO-CDI) in hospitalized patients. Methodology We performed a cross sectional study of 333 patients who developed diarrhoea during hospitalization. The patients were tested for CDI. Data on demographics, admission information, medication exposure and comorbidities were collected. The comorbidities were also categorised according to Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Comorbidity predictors of HO-CDI were identified using multiple logistic regression analysis. Results Overall, 230/333 (69%) patients had comorbidities, with the highest proportion being in patients aged over 60 years. Among the patients diagnosed with HO-CDI, 63/71(88.7%) reported comorbidities. Pairwise comparison between HO-CDI patients and comparison group revealed significant differences in hypertension, anemia, tuberculosis, diabetes, chronic kidney disease and chronic obstructive pulmonary disease. In the multiple logistic regression model significant predictors were chronic obstructive pulmonary disease (odds ratio [OR], 9.51; 95% confidence interval [CI], 1.8–50.1), diabetes (OR, 3.56; 95% CI, 1.11–11.38), chronic kidney disease (OR, 3.88; 95% CI, 1.57–9.62), anemia (OR, 3.67; 95% CI, 1.61–8.34) and hypertension (OR, 2.47; 95% CI, 1.–6.07). Among the comorbidity scores, CCI score of 2 (OR 6.67; 95% CI, 2.07–21.48), and ECI scores of 1 (OR, 4.07; 95% CI, 1.72–9.65), 2 (OR 2.86; 95% CI, 1.03–7.89), and ≥ 3 (OR, 4.87; 95% CI, 1.40–16.92) were significantly associated with higher odds of developing HO-CDI. Conclusion Chronic obstructive pulmonary disease, chronic kidney disease, anemia, diabetes, and hypertension were associated with an increased risk of developing HO-CDI. Besides, ECI proved to be a better predictor for HO-CDI. Therefore, it is imperative that hospitals should capitalize on targeted preventive approaches in patients with these underlying conditions to reduce the risk of developing HO-CDI and limit potential exposure to other patients.

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“…Covariates included in the model were selected a priori and were known to increase risk of contracting CDI. These included recipient age at transplant, pre‐transplant CDI, proton‐pump inhibitor use, high‐risk antibiotic exposure, and total days spent in the ICU . Ultimately, our model excluded proton‐pump inhibitor use, as this was nearly ubiquitous for all patients included in the study due to clinical protocols.…”

Section: Methodsmentioning

confidence: 99%

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

Schluger

Rosenblatt

Knotts

et al. 2019

Transplant Infectious Dis

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Background Clostridioides difficile infection (CDI) is common after solid organ transplant (SOT) and is associated with high morbidity and mortality. Methods We assessed incidence, risk factors, and outcomes of CDI among SOT patients at a large multi‐organ transplant center. Multivariable logistic regression was used to identify risk factors for initial and recurrent CDI. Results A total of 2622 SOT patients were included. 224 (8.5%) had CDI 1 year post‐SOT. The highest incidence of CDI was among pancreas recipients (12.5%) followed by lung (11.7%), liver (11.0%), heart (10.8%), and kidney (5.8%). Median time to CDI was 56 days (range 2‐354) post‐SOT. About 64% of patients had severe CDI. About 56.3% were treated with metronidazole, 13.8% with oral vancomycin, and 28.6% with both. About 28.6% of patients had recurrent CDI. In multivariable modeling, lung transplant recipient status was the only significant predictor of recurrent CDI (OR 4.97, 95% CI 2.11‐11.78, P < .001) controlling for age, severe CDI, and pre‐SOT CDI. Post‐SOT CDI nearly doubled the risk of mortality at one year, in particular among those with severe CDI. Conclusions In summary, CDI is highly prevalent, occurs early in the post‐transplant period, usually severe, with a high rate of recurrence, and associated with increased mortality within 1 year after transplant. The early post‐transplant period may be a crucial window to reduce CDI rates.

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Recurrent Clostridium difficile infection in intensive care unit patients

Cited by 12 publications

References 12 publications

Risk Factors Associated With Recurrent Clostridium difficile Infection

Risk Factors Associated With Recurrent Clostridium difficile Infection

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

Clostridioides difficile infection and recurrence among 2622 solid organ transplant recipients

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