Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort

• Published in: Anaerobe Vol. 44; pp. 117 - 123
• Main Authors: Khanafer, Nagham, Vanhems, Philippe, Barbut, Frédéric, Luxemburger, Christine
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2017
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Case-Control Studies; Clostridium difficile - isolation & purification; Clostridium difficile infection; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Diarrhea - epidemiology; Diarrhea - microbiology; Female; France - epidemiology; Hospitals, University; Humans; Male; Middle Aged; Predictors; Prospective Studies; Risk Factors; Young Adult; Clostridium difficile infection; Risk factors; Predictors
• ISSN: 1075-9964; 1095-8274
• DOI: 10.1016/j.anaerobe.2017.03.003

Clostridium difficile infection (CDI) is a serious medical condition that is associated with substantial morbidity and mortality. Identification of risk factors associated with CDI and prompt recognition of patients at risk is key to successfully preventing CDI.
A 3-year prospective, observational, cohort study was conducted in a French university hospital and a nested case-control study was performed to identify risk factors for CDI. Inpatients aged 18 years or older, suffering from diarrhea suspected to be related to CDI, were asked to participate.
A total of 945 patients were included, of which 233 cases had a confirmed CDI. CDI infection was more common in men (58.4%) (P = 0.04) compared with patients with diarrhea not related to C. difficile. Previous hospitalization (P < 0.001), prior treatment with antibiotics (P = 0.001) or antiperistaltics (P = 0.002), liver disease (P = 0.003), malnutrition (P < 0.001), and previous CDI (P < 0.001) were significantly more common in patients with CDI. Multivariate logistic regression analysis showed that exposure to antibiotics in the last 60 days (especially third generation cephalosporins and penicillins with β-lactamase inhibitor), chronic renal or liver disease, malnutrition or previous CDI, were associated with an independent high risk of CDI. Age was not related with CDI.
This study showed that antibiotics and some comorbid conditions were predictors of CDI. Patients at high risk of acquiring CDI at the time of admission may benefit from careful monitoring of antibiotic prescriptions and early attention to infection control issues. In future, these “high-risk” patients may benefit from novel agents being developed to prevent CDI.
•A recognition of patients at high risk for CDI is a key to successfully prevention.•Antibiotics and some underlying conditions are associated with high risk for CDI.•Chronic renal or liver disease, and malnutrition were associated with high risk.•Advanced age was not related with CDI.