Risk Factors for Primary Clostridium difficile Infection; Results From the Observational Study of Risk Factors for Clostridium difficile Infection in Hospitalized Patients With Infective Diarrhea (ORCHID)

Abstract

Background: There are inconsistent data on the risk factors for Clostridium difficile infection (CDI) in the literature. Aims: To use two C. difficile infection (CDI) case-control study groups to compare risk factors in hospitalized patients with diarrhea across different countries. Methods: A multi-center group of CDI cases/controls were identified by standardized testing from seven countries from the prior EUropean, multi-center, prospective biannual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhea (EUCLID). A second group of CDI cases/controls was identified from a single center in Germany [parallel study site (PSS)]. Data were extracted from the medical notes to assess CDI risk factors. Univariate analyses and multivariate logistic regression models were used to identify and compare risk factors between the two groups. Results: There were 253 and 158 cases and 921 and 584 controls in the PSS and EUCLID groups, respectively. Significant variables from univariate analyses in both groups were age ≥65, number of antibiotics (OR 1.2 for each additional antibiotic) and prior hospital admission (all p < 0.001). Congestive heart failure, diabetes, admission from assisted living or Emergency Department, proton pump inhibitors, and chronic renal disease were significant in PSS (all p < 0.05) but not EUCLID. Dementia and admitted Davies et al. Risk Factors for CDI with other bacterial diseases were significant in EUCLID (p < 0.05) but not PSS. Following multivariate analyses, age ≥ 65, number of antibiotics and prior hospital admission were consistently identified as CDI risk factors in each individual group and combined datasets. Conclusion: Our results show that the same CDI risk factors were identified across datasets. These were age ≥ 65 years, antibiotic use and prior hospital admission. Importantly, the odds of developing CDI increases with each extra antibiotic prescribed.

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

“…Most of these comorbidities would necessitate polypharmacy and prolonged hospital admission directly influencing the shift from C. difficile colonization to subsequent CDI [13]. Consistent with previous studies, independent comorbidities including hypertension, chronic kidney disease, anemia, diabetes, chronic obstructive pulmonary disease as well as aggregate Charlson Comorbidity scores and Elixhauser Comorbidity scores were significantly associated with increased risk of HO-CDI [5,8,14].…”

“…considering additional conditions such as hypertension, weight loss, obesity and psychiatric disorders that are excluded from other indices. Higher Charlson and Elixhauser comorbidity scores have previously been correlated with CDI and represent an increased likelihood of developing HO-CDI [5,7,8].…”

“…Previous studies have attempted to describe comorbidities commonly associated with HO-CDI and they have shown that chronic kidney disease, HIV/AIDS and other immunodeficiency disorders, chronic obstructive pulmonary disease, inflammatory bowel disease, hematological malignancy, and diabetes mellitus increase the risk of both initial and recurring CDI [3][4][5][6]. Other comorbidities that have been implicated include cardiovascular disease, digestive disorders, dementia, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and myocardial infarction [7,8]. However, the actual pathophysiological mechanisms and specific relationship of how these comorbidities influence the development of CDI is not well understood [6].…”

How Does COVID-19 Pandemic Impact on Incidence of Clostridioides difficile Infection and Exacerbation of Its Gastrointestinal Symptoms?

“…Indeed, alteration of the intestinal microbiome of COVID-19 patients who are treated with broad-spectrum antibiotics, is reported to be associated with escalated clinical status such as proinflammatory conditions, disease severity, fecal shedding of the virus, plasma concentrations of several cytokines and finally drastic long-term effects on host health ( 35 , 116 , 117 ). These traceable alterations of the microbiome of COVID-19 patients following the use of antibiotics can lead to dysbiosis of the microbiome and CDI ( 118 ). The use of antibiotics in COVID-19 pneumonia increases the risk of antibiotic-associated diarrhea (AAD) and CDI.…”

Antimicrobial Use in Pediatric Oncology and Hematology: Protocol for a Multicenter Point-Prevalence Study With Qualitative Expert Panel Assessment

“…Ill-advised, excess use of antimicrobials has been associated with the epidemiological increase of antimicrobial resistance, an imminent global health care threat. Similarly, at the individual level, severe adverse events such as allergic reactions, acute organ toxicity, or Clostridioides difficile –related enterocolitis can result from antimicrobial use [ 6 - 8 ].…”