Risk Factors of Patients With Diarrhea for Having Clostridioides (Clostridium) difficile Infection

Abstract

Nosocomial infections with Clostridioides (Clostridium) difficile have become an emergent health threat. We sought to define risk factors for a C. difficile infection (CDI) beyond the widely known ones, such as antibiotic use and prior hospital stay. We therefore focused on a group of patients with diarrhea in order to identify risk factors for C. difficile infection among this symptomatic cohort. A total of 121 hospitalized patients from Seesen/Germany with diarrhea were included who submitted a stool sample and were interviewed about their socio-demographic background, lifestyle and state of health using a standardized questionnaire. Antibiotic potential of diuretics was examined by agar diffusion test. C. difficile was identified in 29 patients resulting in a prevalence of 24.0%. The infection was hospital-acquired in most cases (p < 0.001, 82.1%; n = 23/28, versus 29/91, 31.9%). The generally accepted risk factor previous antibiotic use was confirmed in this study (p = 0.002, n = 23/28 CDI patients, 82.1%, versus n = 44/91 non-CDI patients, 48.4%). The following additional risk factors were identified: regular consumption of proton pump inhibitors; PPI (p = 0.011, n = 24/29, 82.8% vs. n = 52/92, 56.5%), CDI patients ate less vegetables (p = 0.001, n = 12/29, 41.4% vs. 69/92, 75.0%). The intake of the diuretic agent torasemid in patients with CDI (p = 0.005, n = 18/29, 62.1%) was higher than in patients without (n = 30/92, 32.6%). More patients with CDI had to undergo a surgery in the previous year (p = 0.022, n = 13/29, 44.8% vs. n = 21/92, 22.8%) and held more birds (p = 0.056, n = 4/29, 13.8%) than individuals of the negative group (n = 3/92, 3.3%). In conclusion, although no antibiotic potential was detected in diuretics, especially torasemid seems to have significant influence for the occurrence of a CDI as well as a nutrition poor in vegetables. A diet rich in vegetables represented a fourfold lower risk for a CDI (OR 0.240, CI (0.0720 - 0.796]).

Island biogeography theory provides a plausible explanation for why larger vertebrates and taller humans have more diverse gut microbiomes

“…We hypothesized that this association between height, diversity, and CDI could be influenced by diet, as prior research has shown that increasing consumption of a larger variety of plants is positively associated with gut microbiome alpha diversity, and more specifically, eating fewer vegetables has been found to be a risk factor for CDI [ 69 , 70 ]. We partitioned our analysis by self-reported vegetable consumption, looking at differences in height between those with or without a history of CDI in high and low vegetable consumption groups.…”

“…In a prior study, CDI patients tended to report consuming fewer vegetables than individuals without CDI, highlighting the role of diet in CDI prevention [ 69 ]. Dietary plant intake has a stronger positive influence over diversity than almost any other lifestyle factor in human cohorts [ 9 , 13 , 91 , 92 ].…”

Molecular epidemiology and clinical characteristics of Clostridioides difficile infection in patients with inflammatory bowel disease from a teaching hospital

“…In this study, most patients with IBD were younger than 60 years old and the comorbidity burden rate was very low, which is different from the general CDI population. 34 , 35 , 36 In the general population, clindamycin, extended‐spectrum cephalosporins and fluoroquinolones have been reported to be associated with CDI. 35 Similar antibiotics were prescribed in 21.5% of IBD cases in this study.…”

Clostridioides difficile Infection in Liver Cirrhosis: A Concise Review

“…Of note is that community-based CDI is incrementally on the rise, further exacerbating the disease burden associated with CDI [ 10 ]. Antibiotic use [ 11 ], old age [ 12 ], gastric acid inhibitors [ 13 ], and hospitalization [ 14 ] are the critical risk factors for the development of such infections.…”