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 bi-annual 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 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.
Highlights
The importance of Clostridium difficile as a healthcare-associated infection is well-established
The first group of cases and controls were based on a point prevalence study of C. difficile infection (CDI) [EUropean, multi-center, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhea (EUCLID)] and included 59 hospitals in seven countries across Europe that were identified as having higher rates of infection (Czech Republic, Germany, Hungary, Poland, Portugal, Romania, and Slovakia) [22]
Age ≥ 65 years was significantly associated with cases of CDI compared with controls
Summary
The importance of Clostridium difficile as a healthcare-associated infection is well-established. The US Centers for Disease Control and Prevention (CDC) has designated this pathogen as one of the top three antibiotic resistant threats, emphasizing its impact on both patients and the healthcare economy [1,2,3,4]. New treatment options are being developed [5,6,7,8], but prevention of C. difficile infection (CDI) is a key goal. Vaccination against C. difficile and interventions to block the deleterious effects of antibiotics on the gut microbiome are being pursued as prevention options [6]. Preventative approaches require appropriate identification of patients at risk to optimize both the feasibility of clinical trials and the cost-effectiveness of such interventions. There are inconsistent data on the risk factors for Clostridium difficile infection (CDI) in the literature
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