Risk Factors For Clostridium Difficile Infection Research Articles

Analysis of risk factors for community-acquired Clostridioides difficile diarrhea in children: a case-control study in Chenzhou, China.

Most previous studies on Clostridium difficile infection (CDI) mainly focused on adults with underlying diseases or critical illnesses. However, the number of CDI cases in children has also significantly increased, especially the growth of community-acquired CDI, which has attracted attention. This study was conducted to examine the toxin gene characteristics and the risk factors associated with community-acquired CDI (CA-CDI) in children with diarrhea. Children with diarrhea before admission or within 48 hours of hospitalization were included in the study. Stool samples were collected from children with community-acquired diarrhea who were treated at the Children's Hospital of the First People's Hospital of Chenzhou, China from June of 2021 to June of 2022. Fluorescence real-time polymerase chain reaction was utilized to detect Clostridioides difficile (CD) toxins A (tcdA) and B (tcdB) genes as well as binary toxin gene A (cdtA) and B (cdtB) in the specimens cultured for CD. Each child with CA-CDI was matched with four control children of the same sex, age, and place of residence. Necessary clinical data were extracted from the hospital's electronic medical record system. Then, a multivariate conditional logistic regression analysis was applied to identify potential risk factors for CA-CDI. Sixteen (8.3%) of the 193 stool specimens who tested positive for CD were selected for the case group, and their matching 64 control patients were in the study cohort. The breakdown of the CD genotypes of the 16 positive cases were follows: 14 (tcdA+ and tcdB+) (7.25%) and 2 (tcdA+ and tcdB-) (1.04%). The cdtA and cdtB binary toxin genes were negative in all. The results of multivariate conditional logistic regression analysis identified antibiotic use within the previous month [odds ratio (OR) =5.13; 95% confidence interval (CI): 1.65-15.91] and non-breastfeeding (OR =4.89; 95% CI: 1.11-21.53) as independent risk factors for CDI in pediatric patients experiencing community-acquired diarrhea. Children who had been treated with antibiotics and not breastfed were more susceptible to CDI. Therefore, in order to prevent and to control the spread of CD infection, being prudent to the aforementioned high-risk factors is strongly advocated in clinical practice.

Vedolizumab does not increase risk of clostridium difficile infection in patients with inflammatory bowel disease using vedolizumab: A retrospective cohort study

IntroductionSeveral studies have shown increased incidence, recurrence, and severity of Clostridium difficileinfection (CDI) over the last decade. Patients with inflammatory bowel disease (IBD) who develop CDI are more prone to morbidity and mortality than CDI in patients without IBD. This study seeks to evaluate whether IBD patients who use vedolizumab are at increased risk of CDI compared to IBD patients using other therapies. MethodsThis was a retrospective cohort study, and 684 patients with confirmed IBD (228 on vedolizumab, 228 on anti-TNF, and 228 on 5- Aminosalicylates acid therapy) were enrolled from January 2009 to August 2019 at a tertiary referral IBD center at McMaster University Medical Centre (MUMC) in Hamilton, Ontario, Canada. The primary outcome was time to the development of CDI in IBD patients using different therapies. Secondary outcomes included rates of CDI and the association between baseline variables and risk of CDI. A Cox proportional hazards (PH) model was used to evaluate baseline factors and development of CDI. ResultThere was no difference in time to CDI between the three treatment groups (log rank p-value 0.37). CDI occurred in 16 patients (2.3%), specifically four patients (1.75%) in the vedolizumab group, four patients (1.75%) in the anti-TNF group, and eight patients (3.5%) in the 5-ASA group. The Cox PH model found current smoking, older age, and concomitant immunomodulator use as risk factors for CDI, after adjustment for other covariates. Vedolizumab was not associated with increased risk of CDI in the model. ConclusionBiologic therapy with vedolizumab or anti-TNF did not impact risk of CDI. Risk factors for CDI in IBD patients included smoking, older age at the onset of medication, and immunomodulator therapy. Clinicians should have high degree of suspicion for CDI in IBD patients presenting with diarrhea, particularly in those with risk factors identified in this study.

Clostridium difficile Infection Risk Factors and Outcomes Among Inpatients Infected with NAP1/BI/027 Strain Compared to Non-NAP1 Strain in a Major Chinese Hospital

Background: NAP1/027 Clostridium difficile infection (CDI) has rarely been reported in China. Objectives: The objective of this study was to strengthen the understanding of the risk factors and outcomes of NAP1/027 CDI. Methods: A single-center, retrospective, case-control (1: 3) study was performed to identify risk factors and outcomes specific to NAP1/027 CDI using a group of patients with NAP1/027 CDI (n = 20) and a group of age-matched control patients with non-NAP1/027 CDI (n = 60) within June 2018 and August 2021. The patient charts were thoroughly reviewed to assess the markers of severity, risk factors, and outcomes. Results: Out of the 272 stool specimens, 41 cases (15.07%) tested positive for the NAP1 strain of C. difficile using the polymerase chain reaction. Among these specimens, 20 cases fulfilled the inclusion criteria. No significant difference was observed between the NAP1/027 and non-NAP1/027 groups in disease severity, length of hospital stay, or mortality. Logistic regression analysis revealed that risk factors for acquiring NAP1/027 infection included hospitalization in the 90 days before CDI diagnosis and high C-reactive protein level within ± 3 days of C. difficile detection. Conclusions: In a large non-epidemic tertiary hospital in China, NAP1/027 strains were more prevalent in patients with previous hospitalization and high CRP level than non-NAP1/027 strains.

Clostridium difficile infection and immune mediated diarrhea and colitis in patients with cancer on immune checkpoint inhibitors.

e14683 Background: Immune checkpoint inhibitors (ICIs) have altered the landscape of cancer treatment. ICIs are associated with immune mediated diarrhea and colitis (IMDC) which can be challenging to diagnose and differentiate from other etiologies of diarrhea. Clostridium difficile infection (CDI) is a common cause of diarrhea in patients with cancer and can have similar symptoms. In a similar study, CDI was found to be relatively common in ICI-treated cancer patients and especially those with IMDC requiring immunosuppressants. Our study evaluates the incidence of CDI and IMDC in patients with ICI exposure and compares clinical characteristics between the two to determine risk factors that may predispose patients to CDI or IMDC. Methods: This is a retrospective, single-center study of cancer patients on an ICI from 1/1/2011 to 4/7/2022 who were tested for Clostridium difficile with stool nucleic acid amplification tests during or after treatment with an ICI. Patients were determined to have CDI if clinically suspected and had to have a positive stool GDH Ag along with positive C. difficile toxins A & B or a positive stool C. difficile toxin B gene. Patients with positive GDH Ag in the stool but with negative toxins A&B were determined to be colonized. The diagnosis of IMDC was based on the clinical presentation and had to be made by the treating oncologist. Results: 375 patients met our study criteria and got CDI testing at any point during or after ICI exposure. 27 patients tested positive for CDI, whereas 24 were colonized. 105 patients were determined to have IMDC and 97/105 received treatment with steroids or immunosuppressants. Among patients determined to have IMDC, 6 were colonized for clostridium difficile. There were no patients with IMDC who were also positive for clostridium difficile. 71 patients were on a dual ICI regimen whereas 304 patients were on a single ICI. In patients on the dual ICI regimen, 67.6% were diagnosed with IMDC when compared to patients on a single ICI regimen where 18.8% of patients were diagnosed with IMDC (p<0.0001). The absolute lymphocyte count on the day of CDI testing was 1.185 ± 0.066 in the IMDC group when compared to 0.948 ± 0.044 in the non-IMDC group (p=0.003). The mean duration of diarrhea was longer in the IMDC group at 16.905 ± 1.211 days when compared to the CDI group at 9.852 ± 2.387 days (p= 0.0094). Smoking status, sex, history of autoimmunity, and history of prior immune related adverse events did not impact incidence of IMDC or CDI. Conclusions: IMDC was a common cause of diarrhea in patients with ICI exposure who were tested for CDI. We did not find IMDC to be a risk factor for CDI. IMDC has a longer duration of diarrhea and colitis symptoms when compared to CDI. The absolute lymphocyte count on symptom onset is higher in patients with IMDC when compared to patients with CDI and may be useful in identifying patients with IMDC earlier.

The prevalence and clinical characteristics of Clostridium difficile infection in Saudi patients admitted with inflammatory bowel disease: A case-control study.

Inflammatory bowel disease (IBD) patients are at increased risk of Clostridium difficile infection (CDI), causing significant morbidity and mortality. This study examined CDI's prevalence, predisposing factors, and clinical outcomes in Saudi hospitalized IBD patients. : A retrospective case-control study was conducted at a tertiary medical city in Riyadh, Saudi Arabia. All Saudi adult patients with IBD, admitted over the preceding four years were identified from the hospital's database. Eligible patients were divided into those with CDI and those without CDI. Binary logistic regression was used to determine the predisposing factors for CDI among admitted IBD patients. During the study period, 95 patients were admitted with IBD. Crohn's disease (CD) was the predominant type (71.6%), whereas 28.4% of the patients were with ulcerative colitis (UC). Only 16 (16.8%) patients had positive CDI. CDI-positive patients tend to have hypertension and previous use of steroids. Patients with UC tend to have a higher risk of CDI than those with CD. Most patients recovered from the CDI (81.3%) with a median time to CDI clearance of 14 days. Three patients (18.8%) had recurrent CDI; among them, one died. The prevalence of CDI in Saudi IBD patients is similar to that reported elsewhere. UC, steroid treatment, and hypertension are risk factors for CDI in IBD patients. Recurrence of CDI in IBD patients is common and associated with a poor prognosis.

S1567 Celiac Disease Patients Have Higher Risk for Clostridium difficile Infections: A Population-Based Study

Introduction: Clostridium difficile infection (CDI) is a common gastrointestinal pathology with the incidence in the United States to 20-30 per 100 000 population. Previous studies showed association of Celiac disease and CDI, however the prevalence of CDI in patients with celiac disease has not been described in literature. Our aim is to estimate the prevalence of CDI among celiac patients, and to assess whether celiac disease is an independent risk factor for CDI. Methods: A large multi-center database (Explorys Inc., Cleveland, OH, USA) of aggregated electronic health records of 26 different healthcare systems with a total of 360 hospitals and more than 70 million patients across the United States was utilized for this study. A cohort of patients with Celiac disease was identified. Later, a second sub-cohort of those who also had CDI was identified. We excluded all the patients age < 18, patients with inflammatory bowel diseases, immunosuppressed, HIV, Roux-en-Y bypass. Statistical Package for Social Sciences (SPSS version 25, IBM Corp) was used for statistical analysis, and for all analyses, a 2-sided P-value of < 0.05 was considered statistically significant. Multivariate analysis was performed to adjust for multiple factors including age, sex, race, smoking, use of proton pump inhibitors, diagnosis of celiac disease. Results: Among the 80,884,400 individuals screened in the database there were total of 143,180 with Celiac disease (0.17%). The baseline characteristics of patients with Celiac disease are represented in Table. Celiac disease was independently associated with a higher risk of developing CDI (OR= 2.592). Other factors associated with risk of CDI included age 18-65 (OR= 2.764), White race (OR =1.880), smoking (OR= 1.540), use of proton pump inhibitors (OR= 8.468) as in the Figure. Conclusion: Celiac disease seems to be an independent risk factor for CDI. Further studies are required to investigate specifics of pathophysiology, diagnosis and treatment of CDI in patient with celiac disease.Figure 1.: Multivariable analysis for risk factors in individuals with Clostridium Difficile Infection Table 1. - Baseline Catachrestic of Study Population. Celiac disease (%)N=143,180 No celiac disease (%)N=80,741,220 Age 18-65 9,7340 (67.9) 47,893,510 (59.3) >65 39,400 (27.5) 21,266,990 (26.2) Sex Male 1,640 (1.15) 189,850 (0.24) Race Caucasian 117,430 (82.0) 42,011,260 (52.0) Comorbidities Clostridium difficile 2,050 (1.43) 231,830 (0.29) Hypertension 45,710 (31.9) 14,183,650 (17.5) Type 2 Diabetes 20,050 (13.9) 5,651,930 (6.9) Hyperlipidemia 51,170 (35.7) 11,782,380 (14.5) Smoking 19,480 (13.6) 3,874,810 (52.0) Medications PPI 54,790 (38.27) 86,37,610 (10.70)

Ischemic Colitis Is a Risk Factor for Clostridium difficile Infection.

Introduction: Clostridium difficile infection (CDI) is an anaerobic infection that can carry detrimental outcomes for patients and is a growing burden to the US healthcare system. Various theories have been proposed for the etiopathogenesis of CDI, including antibiotic use, dysbiosis, and acid suppression. The role of ischemia in CDI has not been explored. We hypothesize that tissue ischemia is a risk factor for the development of CDI. The study aimed to assess whether ischemia was a risk factor for CDI using ischemic colitis as a target population.Methods: We performed a case-control study using the National Inpatient Sample (NIS) database in 2013. The study group included all patients with ischemic colitis (ICD 9 Code: 557.0, 557.1, 557.9) and the control group included all patients with diverticulitis (ICD 9 Code: 562.11, 562.13). Univariable and multivariable analyses were performed to assess the risk factors associated with CDI (ICD 9 Code: 008.45). The case and control groups were compared using the chi-square test for analysis. Continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. In addition, multivariable logistic regression analysis was performed to assess the association between disease group and CDI while adjusting for confounders. Univariable analysis was performed to assess differences between subjects with ischemic colitis and those with diverticulitis; continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. All analyses were done using SAS (version 9.4, The SAS Institute, Cary, NC).Results: We analyzed more than 30 million hospitalizations in 2013, with 120,490 being Ischemic colitis-related admissions and 309,940 being diverticulitis-related admissions. The rate of CDI was more in the ischemic colitis group than in the diverticulitis group (odds ratio [OR] = 1.39; 95% confidence interval [CI] [1.03-1.88], p=0.03). After adjusting for all variables, multivariate analysis showed CDI was associated with ischemic colitis (OR = 2.06; 95% CI 1.59-2.65, p<0.001).Conclusion: CDI was shown to be more prevalent in ischemic colitis than in diverticulitis control in this population-based study. As C. difficile is an anaerobe, we hypothesize that tissue hypoxia is a risk factor for its development. Further studies are needed to validate our findings.

The epidemiological and clinical study of patients with &lt;i&gt;clostridium difficile&lt;/i&gt; enterocolitis in Varna, Bulgaria

Introduction. Clostridium difficile infections (CDI) remain a global health concern. Currently, no unified approach to the diagnostics and determining severity of these infections despite their high urgency throughout the world was proposed. The aim of the study is to identify risk factors for CDI, investigate clinical and epidemiological features of the disease course and potential for using the ATLAS scale to assess its severity. Materials and methods. 36 CDI patients hospitalized at the Infectious Disease Clinic of Varna were analyzed during the period from January 2018 until June 2019. Clinical and epidemiologic study was conducted. The diagnosis was made by using a rapid immunochromatographic test; CDI patient stratification was performed by ATLAS scoring system. Results and discussion. Within the aforementioned period, 1100 patients were hospitalized at the Infectious Disease Clinic of Varna, and CDIs were reported in 3,3% of cases. The most affected were elderly individuals (the mean age was 69,816,4 years old) most of whom were females (92%) with only 6% of males. The following risk factors were investigated: comorbidities 32 patients (88,89%), recent hospitalization 19 patients (52,78%), antibiotic use 31 patients (86,11%). Twenty-four patients (66,67%, ATLAS score 4 points) had mild CDI, whereas moderate form of CDI was observed in 12 patients (33,33%). No severe CDI or death were observed. The characteristic clinical presentation included fever, diarrhea and abdominal cramping. The treatment was implemented according to the national and international recommendations by using oral Metronidazole for 11 patients (30,56%), Vancomycin for 12 patients (33,33%), or both for 13 patients (36,11%). Conclusion. Patients at risk with symptoms of enterocolitis and a history of antibiotic use or hospitalizations should be screened for the presence of toxin-forming strains of Clostridium difficile. According to the European Centre for Disease Prevention (ECDC) the diagnostic yield of CDI may be increased by using two-step protocol, whereas the ATLAS score system may be a useful tool for routine evaluation of patients with CDI.

Clostridium difficile infection after ileostomy closure and anastomotic failure in rectal cancer surgery patients.

BackgroundDiverting ileostomy during resection of rectal cancer is frequently performed in patients at risk of anastomotic failure. Clostridium difficile infection (CDI) is reported to be frequent in patients who receive ileostomy closure with a questionable association to postoperative anastomosis leak. The primary aim of this study was to determine the incidence of CDI following ileostomy closure in patients who underwent rectal cancer surgery; the secondary aim was to assess the rate of postileostomy closure CDI in patients who presented with leakage at the original colorectal anastomosis site.MethodsMedical records of patients with rectal cancer who underwent ileostomy closure between January 2015 and December 2019 were retrospectively reviewed. All patients had previously received resection and anastomosis for primary rectal cancer with diverting ileostomy. Data regarding CDI incidence, preoperative status, perioperative management, and clinical outcomes were collected. CDI positivity was determined by direct real-time PCR and enzyme-linked fluorescent assays for detecting toxin A and B.Statistical analyses were computed for CDI risk factors.ResultsA total of 1270 patients were included and 208 patients were tested for CDI owing to colitis-related symptoms. The incidence of CDI was 3.6 per cent (46 patients). Multivariable analysis for CDI risk factors identified adjuvant chemotherapy (hazard ratio (HR) 2.28; P = 0.034) and colorectal anastomosis leakage prior to CDI (HR 3.75; P = 0.008). Finally, patients with CDI showed higher colorectal anastomosis leakage risk in multivariable analysis after ileostomy closure (HR 6.922; P = 0.001).ConclusionPatients with CDI presented with a significantly higher rate of colorectal anastomosis leakage prior to ileostomy closure.

Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

BACKGROUND Clostridium difficile infection (CDI) has increased in prevalence during the last years. The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced patient outcomes. The majority of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-infected patients received antibiotics during hospitalization.AIMTo analyze the factors that influenced CDI development after SARS-CoV-2 infection. METHODSBetween March 2020 to December 2020, we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital. The diagnosis of CDI was based on the presence of diarrhea (≥ 3 watery stools within 24 h) associated with Clostridium difficile toxins A or B. We excluded patients with other etiology of acute diarrhea.RESULTSAmong the total 447 (12.5%) patients with CDI, most were male (54.3%) and mean age was 59.7 ± 10.8 years. Seventy-six (17.0%) had history of COVID-19, most being elderly (COVID-19: 62.6 ± 14.6 years vs non-COVID-19: 56.8 ± 17.6 years, P = 0.007), with history of alcohol consumption (43.4% vs 29.4%, P = 0.017), previous hospitalizations (81.6% vs 54.9%, P < 0.001) and antibiotic treatments (60.5% vs 35.5%, P < 0.001), requiring higher doses of vancomycin and prone to recurrent disease (25.0% vs 13.1%, P = 0.011). Age over 60 years [odds ratio (OR): 2.591, 95% confidence interval (CI): 1.452-4.624, P = 0.001], urban residence (OR: 2.330, 95%CI: 1.286-4.221, P = 0.005), previous antibiotic treatments (OR: 1.909, 95%CI: 1.083-3.365, P = 0.025), previous hospitalizations (OR: 2.509, 95%CI: 1.263-4.986, P = 0.009) and alcohol consumption (OR: 2.550, 95%CI: 1.459-4.459, P = 0.001) were risk factors of CDI in COVID-19.CONCLUSIONCDI risk is unrelated to history of SARS-CoV-2 infection. However, previous COVID-19 may necessitate higher doses of vancomycin for CDI.

Evaluating Risk Factors and Outcomes For Clostridium Difficile Infection (CDI) In Stem Cell Transplant (SCT) Recipients

IntroductionClostridium difficile infections (CDI) are the leading cause of infectious diarrhea among pts undergoing stem cell transplantation (SCT). Data from large pt samples evaluating the trends, risk factors, hospitalization outcomes are lacking. We have analyzed the Nationwide Inpt Sample (NIS) database to evaluate the trends in the incidence and the impact of CDI on hospitalization outcomes among SCT recipients. MethodsWe used the NIS database to obtain the hospitalization data for primary procedures of autologous and allogeneic SCT between 01/2001 until 12/2010. We performed separate multivariate logistic regression analyses to evaluate risk factors of CDI in SCT pts and hospitalization outcomes including length of stay (LOS), in-hospital mortality (IHM) and hospitalization charges. Comorbidites were identified using software that created measures reported by Elixhauser et al. ResultsThe incidence of CDI among transplant pts has remained relatively stable over time (Fig 1), with a higher cumulative incidence of CDI among recipients of allogeneic grafts (allogeneic vs. autologous SCT: 8.29% vs. 5.63%; p<0.001). There was an association between CDI and the presence of multiple comorbidities among autologous SCT pts (p=0.05), and a similar trend was seen in allogeneic transplant pts. Mean LOS (CDI vs. none: autologous 26 vs. 20 days, p<0.0001; allogeneic 42 vs 30 days, p<0.001; respectively), IHM (CDI vs. none: autologous, 4.0 vs. 2.2%, p=0.0003; allogeneic 12.7 vs 9.2%, p=0.0008) and mean hospitalization charges (CDI vs. none: autologous $208,025 vs. $145,250, p<0.0001; allogeneic $367,415 vs $270,366 p<0.0001; respectively) were significantly higher among SCT pts with CDI (Table 1). [Display omitted] Table 1Pt characteristics, multivariate regression models for evaluating risk and outcomes of SCT pts with CDIAutologous SCTAllogeneic SCTCDI (%) (N=3772)SCT patients (%) (N=63202)p-valueCDI (%) (N=3440)SCT patients (N=38066)p-valueMean age (SE)54.3 (0.52)52.02 (0.27)<0.000145.07 (0.64)46.57 (0.38)<0.0098Male2311 (61.3)37038 (58.6)0.15962188 (63.6)21906 (57.6)0.0005White2369 (77.4)26124 (74.3)0.10892199 (77.7)23695 (78)0.847Comorbidities ≥12945 (78)46872 (74.2)0.052607 (75.8)27712 (72.8)0.1073Medicare945 (25.1)12460 (19.8)<0.0001310 (9.0)4111 (10.8)0.183Medicaid330 (8.8)6818 (10.8)0.1161474 (13.8)3996 (10.5)0.0126Private Insurance2320 (61.6)40209 (63.8)0.24832486 (72.4)27601 (72.7)0.8798Mean LOS (SE)*26 (0.71)20 (0.27)<0.0001*42 (1.59)30 (0.68)<0.0001*IHM152 (4.0)1330 (2.1)0.0003438 (12.7)3360 (8.8)0.0008Charge Mean (SE)208025 (8370.6)145250 (4311.3)<0.0001*$367415 (15033)$270366 (11835)<0.0001*Multivariate logistic regression model evaluating risk of CDI in SCT patientsVariableOdds RatioRefp-valueOdds RatioRefp-value≥651.4 (0.987-1.985)Age <40 (Ref)0.19450.637 (0.426-0.953)0.0834Male1.25 (1.054-1.483)Female (Ref)0.01031.351 (1.157-1.576)Female (Ref)0.0001Medicare1.149 (0.878-1.502)Private (Ref)0.04390.85 (0.581-1.244)Private (Ref)0.4605Medicaid0.887 (0.642-1.226)0.76731.269 (0.920-1.749)0.0272No Comorbidities0.831 (0.650-1.063)Comorbidities ≥10.14060.829 (0.672-1.024)Comorbidities ≥10.082 ConclusionsThe incidence of CDI among both autologous and allogeneic SCTs have remained stable over the last decade, with a slightly higher risk among allogeneic SCT pts. CDI was associated with longer hospital stay, higher charges and higher IHM for both autologous and allogeneic transplant pts. While this analysis does not permit us to directly ascribe differences in outcome to CDI alone, these data suggest that CDI has a major morbid impact in the setting of SCT, and provides a rationale for development of more effective approaches for prevention of CDI in these pt populations. Disclosures:Kaufman:Onyx: Consultancy; Celgene: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Janssen: Consultancy; Millenium: Consultancy; Merck: Research Funding. Lonial:Millennium: Consultancy; Celgene: Consultancy; Novartis: Consultancy; BMS: Consultancy; Sanofi: Consultancy; Onyx: Consultancy.Multivariate logistic regression model evaluating hospitalization outcomes in SCT patients with CDI #CDIAbsencePresencep-valueCDIAbsencePresencep-valueLOS >19 days0.382 (0.31-0.466)1.00 (Ref)<0.0001LOS > 27 days0.337 (0.27-0.42)1.00 (Ref)<0.0001Charge > $125,0910.483 (0.40-0.58)<0.0001Charge > $22,60110.487 (0.38-0.67)<0.0001IHM0.68 (0.44-1.06)0.089IHM0.661 (0.50-0.87)0.0037SE: Standard error; *adjusted for age, race, sex, comorbidity and payer status.#Median LOS and charges used as cut-off for hospitalization outcomes

Clostridium difficile infection Risk factors and potential vaccines

Clostridium difficile infection Risk factors and potential vaccines

Clinical Characteristics of Patients with Clostridium Difficile Infection and Its Relationship with Fecal Occult Blood Test

Clostridium difficile infection (CDI) is an important health problem with severe morbidity and mortality. In our study, 266 adult patients admitted to the hospital between the years 2005 and 2020, and were diagnosed with CDI were included. The relationship between CDI and fecal occult blood test (FOBT) was examined, and it was aimed to determine the clinical characteristics of CDI patients and risk factors for mortality and recurrence in these patients. FOBT was found to be positive in 42.8% of our CDE patients who had occult blood in stool. Pseudomembranous enterocolitis (PME) developed in 2.2% of our patients and toxic megacolon developed in 0.8%; while 10.2% of the patients had a mortal course within 30 days and 5.2% of them had a recurrence. In our study, a significant relationship was found between mortality and advanced age, negativity of FOBT, presence of hospitalization history, and also between FOBT positivity and the presence of PME and recurrence. We believe that the data documented in this study are important because it both reveal the clinical characteristics of CDI patients and its relationship with FOBT.

791. Evaluation of NSAID Exposure as a Risk Factor for Clostridium difficile infection: A Propensity-Score-Matched Case-Control Study

BackgroundExposure to certain medications, particularly antibiotics and proton pump inhibitors, has been associated with increased risk for Clostridium difficile infection (CDI). Studies have suggested an increased risk for CDI associated with exposure to certain non-steroidal anti-inflammatory drugs (NSAIDs). We conducted a retrospective case-control study to evaluate the risk for CDI associated with NSAID use.MethodsThe population included 1338 patients tested for CDI from February–December 2016 at the University of Michigan. NSAID use within 30 days of CDI testing was determined by chart review. Both scheduled and as-needed NSAID use met the definition for exposure, but aspirin use alone did not. Additional clinical data such as comorbid disease and baseline laboratory parameters were extracted through electronic query. A random forest model imputed missing data. A propensity score for NSAID use was developed via logistic regression and included gender, back pain, baseline serum creatinine, osteoarthritis, rheumatoid arthritis, serum albumin, and use of anticoagulant or antiplatelet medications. Cases were matched 1:1 with C. difficile negative controls by propensity score, with a matching caliper of 0.2 x standard deviation of the logit of the score. The final study population consisted of 1256 cases and their matched controls, however 6 cases could not be matched to controls as none had scores within the matching caliper. Conditional logistic regression was used to compare cases to controls.ResultsNSAID use was similar between the two groups on unadjusted analyses. The adjusted, multivariable model demonstrates that non-aspirin NSAID use is not a significant risk factor for CDI (P =.816), after adjustment for comorbid disease burden, age, and history of prior CDI (Table). Older age and prior CDI were independent risk factors for CDI (Table). Table Study population and modeling results ConclusionIn this retrospective case-control study, non-aspirin NSAID use was not associated with an increased risk of CDI. To our knowledge, this is the first study of NSAID use as a risk factor for CDI that accounted for bias due to treatment assignment using a propensity score. Future studies should account for frequency or chronicity of NSAID use, which may affect the results.DisclosuresKrishna Rao, MD, MS, Bio-K+ International, Inc. (Consultant)Merck and Co., Inc. (Research Grant or Support)Roche Molecular Systems, Inc. (Consultant)

Clostridium Difficile Infection Is Independently Associated with Significantly Worse Outcomes in Acute Leukemia Patients Undergoing Chemotherapy and/or Hematopoietic Stem Cell Transplant

Background: Risk factors for Clostridium difficile infection (CDI) include antibiotic use, prolonged hospitalization, cancer chemotherapy, hematopoietic stem cell transplantation (HSCT) and gastric acid suppression, all of which, are encountered in acute leukemia patients. We sought to examine the impact of CDI on inpatient outcomes and resource utilization, as well as, to evaluate the trends of CDI in acute leukemia patients. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adults with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), who were admitted between 2012 and 2017 for inpatient chemotherapy and/or hematopoietic stem cell transplant (HSCT). Those with and without CDI were compared. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for CDI, as well as, inpatient mortality. Statistical tests for trends of resource utilization across six years were performed. Results: A total of 187,105 admissions met the inclusion criteria, of which, 5.3% had CDI. Mean age (51.3 years) and gender (male 56.4%) did not significantly differ between those with and without CDI. AML accounted for a larger proportion of the CDI group (72.4% vs 64.6%, p&amp;lt;0.0001). CDI was associated with higher rates of inpatient mortality (8.9% vs 4.4%), ICU-level care (8.5% vs 3.7%), shock (9.6% vs 3.6%) and acute kidney injury (21.2% vs 11.1%), p&amp;lt;0.0001 for all outcomes. On multivariate analysis, independent risk factors for CDI included: AML, HSCT, neutropenia, higher comorbidity burden (in the form of Charlson comorbidity index) and being treated at a teaching hospital. Blacks had lower rates of CDI. After adjusting for demographic variables, comorbidities, and accounting for higher proportion of AML, HSCT and neutropenia in the CDI group, CDI still accounted for higher risk for inpatient mortality (aOR 1.76, 95% CI 1.48-2.10, p&amp;lt;0.001), increased length of stay by 9 days (95% CI: 8.0-10.1, p&amp;lt;0.001) and higher hospitalization charges by around $33k per admission (95% CI: $25k-39k, p&amp;lt;0.001). CDI rate in acute leukemia patients remained stable between 2012 to 2017. The mortality rates declined in both groups (9.8% in 2012 to 6.3% in 2017, p&amp;lt;0.01 in the CDI group and 5.7% in 2012 to 1.9% in 2017, p&amp;lt;0.001 in the non-CDI group). Similarly, length of hospital stay improved in both groups (31 to 27 days in CDI group, p=0.04 and 17 to 13 days in non-CDI group, p&amp;lt;0.001). While the hospitalization costs improved significantly in the non-CDI group ($52k to $42k, p&amp;lt;0.001), there was no statistically significant change in the CDI group ($112k to 102k, p=0.90). Conclusions: CDI has a substantial impact on outcomes in acute leukemia patients. Higher incidence of CDI in HSCT recipients may be explained by prolonged hospitalizations, increased antibiotic exposures, and extended periods of impaired host immunity. Additionally, GVHD may also play a role in the incidence of CDI and its outcomes. Despite improvement in outcomes over the years, mortality rates and financial burden of CDI on health care, is still substantially higher in those without CDI, therefore, there is a need to focus on preventive measures. Disclosures No relevant conflicts of interest to declare.

High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections.

To characterize the use of common urinary tract infections (UTI)-relevant antibiotics after an SCI and determine the risk of Clostridium difficile infection (CDI) from these antibiotics. We used routinely collected data from Ontario (Canada) to conduct a retrospective, cohort study. We identified people >18 years of age with a traumatic SCI between April 2003 and March 2017. The primary exposure was an outpatient UTI-relevant antibiotic prescription during our observation period, and the primary outcome was evidence of a CDI. An adjusted cox proportional hazards model was used, and antibiotic exposure was modeled as a categorical, time-varying variable based on whether the patient likely had a UTI or not. We identified 2528 people with SCI; 1642 (65%) were exposed at least once to an antibiotic of interest. The most commonly prescribed UTI-relevant antibiotic was fluoroquinolone (34%). Most patients did not have investigations for a UTI before theuse of any of the different antibiotic classes. A small number of patients (5%) used chronic (>3 months) UTI-relevant antibiotics. The overall proportion of patients diagnosed with CDI was 7.4% (9.3/10 000 patient-days). The adjusted hazard ratio for CDI within 30 days was 3.5 (95% confidence interval, 1.9-6.7, p < .01) if they were exposed to a UTI-relevant antibiotic likely associated with a UTI, which was similar to the risk from UTI-relevant antibiotics which may not have been for a UTI. The rate of CDI is high in this population and outpatient antibiotics that are commonly used for UTIs are a significant risk factor for CDI.

90-Day Specific Readmission for Clostridium difficile Infection After Hospitalization With an Inflammatory Bowel Disease Flare: Outcomes and Risk Factors.

Patients with inflammatory bowel disease (IBD) have an increased risk for Clostridium difficile infection (CDI) and carry significantly higher morbidities and mortality than those without IBD. We aimed to investigate disease-specific readmission rates and independent risk factors for CDI within 90 days of an index hospitalization for an IBD flare. The Nationwide Readmission Database was queried for the year 2016. We collected data on hospital readmissions of 50,799 adults who were hospitalized for urgent IBD flare and discharged. The primary outcome was disease-specific readmission rate for CDI within 90 days of discharge. The secondary outcomes were readmission rate of colonoscopic procedures, morbidities (including mechanical ventilation and shock), and hospital economic burden. The risk factors for readmission were identified using Cox regression analysis. The 90-day specific readmission rate was 0.1% (N = 477). A total of 3,005 days were associated with readmission, and the total health care in-hospital economic burden of readmission was $19.1 million (in charges) and $4.79 million (in costs). Independent predictors during index admission for readmission were mechanical ventilation for >24 hours (hazard ratio [HR], 6.62, 95% confidence interval [CI], 0.80-54.57); history of previous CDI (HR, 5.48; 95% CI, 3.66-8.19); HIV-positive status (HR, 4.60; 95% CI, 1.03-20.50); alcohol abuse disorders (HR, 2.06; 95% CI, 1.15-3.70); Parkinson's disease (HR, 4.68; 95% CI, 1.65-13.31); index admission for noncomplicated ulcerative colitis (HR, 4.72; 95% CI, 2.99-7.45]-), complicated ulcerative colitis (HR, 4.49; 95% CI, 2.80- 7.18), or noncomplicated Crohn disease (HR, 2.54; 95% CI, 2.80-4.04); and hospital length of stay (HR, 1.01; 95% CI, 1.01-1.02). The 90-day CDI-specific readmission rate after the index admission of IBD flares was 0.1%. We found risk factors for CDI-associated readmissions such as history of Parkinson's disease, prior CDI, HIV-positive status, and alcohol abuse disorder. Finally, our study also revealed a high health care cost, charges, and burden.

Observational study in a single institute in Japan: How many community-onset pneumonia patients would have Clostridioides difficile infections after treatment?

While community-onset pneumonia patients such as community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) have several risk factors of Clostridium difficile infection (CDI), prognostic guidelines for pneumonia never mention the occurrence of CDI following treatment for pneumonia. For the purpose of examining the occurrence and prevalence of CDI, we reviewed all community-onset pneumonia patients who were admitted to our institute during the study period.A total of 406 patients were enrolled in this study. Among them, 257 patients (63%) were male, and the median age was 79 years (range 19–103 years). Surprisingly, 155 CAP (88%) and all HCAP (100%) patients had one or more risk factors for CDI. Furthermore, 70 CAP (40%) and 157 HCAP (69%) patients had more than 3 risk factors for CDI. Despite these facts, probiotic medication for prevention of CDI were prescribed for 12 (7%) CAP and 15 (7%) HCAP patients as the initial treatment. Finally, 3% and 9% of CAP and HCAP patients had CDI after completing the treatment for pneumonia. Regarding the duration of antibiotic therapy, 146 CAP (82%) and 176 HCAP (77%) patients received it for longer than 8 days, even though bacteremia was not confirmed in those patients. In addition, 27 CAP (15%) and 26 HCAP (11%) patients received a combination antibiotic therapy as an initial treatment. They seemed to be unnecessary. Physicians should acknowledge community-onset pneumonia has several risk factors for CDI, and should avoid a longer than necessary antibiotic therapy and unnecessary combination antibiotic therapy for pneumonia patients with risk factors for CDI.

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)

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.

Clostridium difficile infection and inflammatory bowel disease.

Over the past 15 years, Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has increased both in incidence and severity. Traditional risk factors for CDI are similar in IBD and non-IBD populations, but there is a significant proportion of IBD patients which have distinctive characteristics. Patients with ulcerative colitis (UC) are more susceptible to CDI and have more severe outcomes than those with Crohn's disease (CD). CDI may be difficult to distinguish from an IBD flare due to similar clinical presentation, and therefore screening for CDI is recommended at every flare in such patients. Several studies showed worse clinical outcomes in IBD patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. Vancomycin and metronidazole appear to have similar efficacy in patients with moderate disease, but vancomycin is preferred in severe disease. Measures must be taken to prevent the spread of infection. Clinicians should have a high index of suspicion for CDI when evaluating a patient with IBD flare, as rapid detection and prompt treatment of infection improve outcomes. This review summarizes the available literature on epidemiology, risk factors, clinical aspects, diagnostic methods, treatment, outcome, and prevention of CDI in IBD patients.