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J Infect. 2016 Jul;73(1):45-53. doi: 10.1016/j.jinf.2016.04.008. Epub 2016 Apr 19.

Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia.

Author information

1
Scottish Centre for Respiratory Research, University of Dundee, Dundee, DD1 9SY, UK. Electronic address: j.chalmers@dundee.ac.uk.
2
Department of Respiratory Medicine, University of Edinburgh, New Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. Electronic address: ahsan.akram@ed.ac.uk.
3
Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, W2 1PG, UK. Electronic address: aransinga@gmail.com.
4
Microbiology Department, Leeds Teaching Hospitals & University of Leeds, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK. Electronic address: mark.wilcox@nhs.net.
5
Department of Respiratory Medicine, University of Edinburgh, New Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. Electronic address: adam.hill318@nhs.net.

Abstract

OBJECTIVES:

Clostridium difficile infection (CDI) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (CAP) is the leading indication for anti-biotic prescription in hospitals. This study assessed the incidence of and risk factors for CDI in a cohort of patients hospitalized with CAP.

METHODS:

We analysed data from a prospective, observational cohort of patients with CAP in Edinburgh, UK. Patients with diarrhoea were systematically screened for CDI, and risk factors were determined through time-dependent survival analysis.

RESULTS:

Overall, 1883 patients with CAP were included, 365 developed diarrhoea and 61 had laboratory-confirmed CDI. The risk factors for CDI were: age (hazard ratio [HR], 1.06 per year; 95% confidence interval [CI], 1.03-1.08), total number of antibiotic classes received (HR, 3.01 per class; 95% CI, 2.32-3.91), duration of antibiotic therapy (HR, 1.09 per day; 95% CI, 1.00-1.19 and hospitalization status (HR, 13.1; 95% CI, 6.0-28.7). Antibiotic class was not an independent predictor of CDI when adjusted for these risk factors (P > 0.05 by interaction testing).

CONCLUSIONS:

These data suggest that reducing the overall antibiotic burden, duration of antibiotic treatment and duration of hospital stay may reduce the incidence of CDI in patients with CAP.

KEYWORDS:

Antibiotics; Clostridium difficile; Healthcare-associated infections; Macrolides; Pneumonia

PMID:
27105657
DOI:
10.1016/j.jinf.2016.04.008
[Indexed for MEDLINE]
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