Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Abstract

BackgroundAn increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.MethodsWe enrolled participants from 10 US sites during October 2014–March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.ResultsOf 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure—that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13–321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01–311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77–340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76–340.05),—emergency department visit (AmOR, 17.37; 95% CI, 1.99–151.22), white race (AmOR 7.67; 95% CI, 2.34–25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20–19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24–118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27–20.79) were associated with CA-CDI.ConclusionsAntibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.

Risk factors and Intestinal Microbiota: Clostridioides difficile Infection in Patients Receiving Enteral Nutrition at Intensive Care Unit

“…Despite the frequent risk factors, we also noticed that history of cerebral infarction was strongly and independently related to CDI, which might be due to old age, low microbial diversity and possible prior long-term exposure to healthcare institutions[17]. Metronidazole is commonly used for CDI, and was still recognized as a protective factor here, consistent with many other studies, which emphasizes its current importance in prevention and treatment in CDI[15,18,19]. Overall, these results have enriched the epidemiological data for CDI and increased our attention to ICU patients receiving EN.EN, always along with prophylactic use of antibiotics and PPIs, are likely to be accompanied by disruption or remodeling of gut microbiota, which plays an essential role in occurrence and development of CDI[9,20].…”

Kajian Penggunaan Antibiotik pada Neonatus Intensive Care Unit di Sebuah Rumah Sakit Pemerintah di Surabaya

“…[27][28][29] Selain memiliki dampak terhadap munculnya ESBL, pemberian dari antibiotik dengan spektrum luas yang tidak bertanggung jawab dapat menimbulkan risiko terjadinya supra infeksi oleh Clostridium difficile. [30][31][32] Dengan mempertimbangkan besarnya risiko adanya infeksi ESBL dan Clostridium difficile, diharapkan penggunaan antibiotik spektrum luas dapat diubah menjadi antibiotik dengan spektrum yang lebih sempit sesuai dengan penyebab infeksi setiap pasien. Sayangnya, pemeriksaan kultur bakteri tidak ditemukan pada penelitian ini.…”

Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spaish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

“…Clostridiodes difficile (CD) is the leading cause of infectious diarrhea in adults in contact with the health-care setting [1,2], but also an increasing proportion of C. difficile infections (CDI) are either community-acquired or of community onset [3][4][5][6][7]. In Spain, the estimated incidence of CDI acquired in relationship with HealthCare Facilities is 6,5 episodes per 10,000 patientdays of admission and 22.3 episodes per 100.000 inhabitants [8], but many episodes remain undetected.…”