Risk factors for Clostridioides difficile colonization among hospitalized adults: A meta-analysis and systematic review

Abstract

Objective: To identify risk factors for asymptomatic Clostridioides difficile colonization among hospitalized adults utilizing a meta-analysis, which may enable early identification of colonized patients at risk of spreading C. difficile. Design: Meta-analysis and systematic review. Methods: We systematically searched MEDLINE, Scopus, Web of Science, and EMBASE from January 1, 1975, to February 15, 2020, for articles related to C. difficile colonization among hospitalized adults. Studies with multivariable analyses evaluating risk factors for asymptomatic colonization were eligible. Results: Among 5,506 studies identified in the search, 19 studies met the inclusion criteria. Included studies reported 20,334 adult patients of whom 1,588 were asymptomatically colonized with C. difficile. Factors associated with an increased risk of colonization were hospitalization in the previous 6 months (OR, 2.18; 95% CI, 1.86–2.56; P < .001), use of gastric acid suppression therapy within the previous 8 weeks (OR, 1.42; 95% CI, 1.17–1.73; P < .001), tube feeding (OR, 2.02; 95% CI, 1.06–3.85; P = .03), and corticosteroid use in the previous 8 weeks (OR, 1.58; 95% CI, 1.14–2.17; P = .006). Receipt of antibiotics in the previous 3 months (OR, 1.37; 95% CI, 0.94–2.01; P = .10) was not associated with statistically significant effects on risk of colonization. Conclusions: C. difficile colonization was significantly associated with previous hospitalization, gastric acid suppression, tube feeding, and corticosteroid use. Recognition of these risk factors may assist in identifying asymptomatic carriers of C. difficile and taking appropriate measures to reduce transmission.

Risk for Asymptomatic Household Transmission of Clostridioides difficile Infection Associated with Recently Hospitalized Family Members

“…Indeed, asymptomatic C. difficile transmission has been posited as an explanation for the missing epidemiologic links in whole-genome sequencing studies (14). Asymptomatic C. difficile colonization among hospitalized patients is not uncommon (12,(17)(18)(19)(20). For example, a meta-analysis found that ≈10% of hospitalized patients in North America become colonized (20).…”

“…Aaron C. Miller, Alan T. Arakkal, Daniel K. Sewell, Alberto M. Segre, Sriram V. Pemmaraju, Philip M. Polgreen; CDC MInD-Healthcare Group C. difficile after discharge (17)(18)(19)(20), this patient population could represent a large reservoir of CDI outside healthcare settings.…”

Gut Microbiota Composition Associated with Clostridioides difficile Colonization and Infection

“…The use of corticosteroids increases the risk of C. difficile colonization in adults admitted to the hospital [ 14 ] and immunosuppressive therapy is a risk factor for complicated CDI [ 15 ]. Immunocompromised patients have a higher risk of developing rCDI during hospitalization [ 16 ].…”

“…A recent hospitalization or a recent intensive care unit stay increases the risk of developing CDI by 2.2 and 6.5, respectively [ 11 ]. Hospitalization in the previous 6 months increases the risk of colonization by 2.18 [ 14 ]. Previous studies showed that in an ambulatory group ( n = 43), in patients with short hospital stays ( n = 48) and in patients with long hospital stays ( n = 102), the percentages of C. difficile carriage were 9.5%, 8% and 13%, respectively [ 17 ].…”

Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile

“…Another risk concerns antibiotic classes: late-generation cephalosporins and carbapenems present a higher risk [ 21 ], but even relatively narrow-spectrum antibiotics, such as ampicillin, are associated with CDI. A recent work by Anjewierden et al [ 22 ] has identified risks for asymptomatic CDI, such as hospitalization within six months prior to infection, nasogastric tube feeding, use of gastric acid suppression therapies, as well as use of corticosteroids in the previous eight weeks.…”