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Anaerobe. 2017 Apr;44:117-123. doi: 10.1016/j.anaerobe.2017.03.003. Epub 2017 Mar 6.

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

Author information

1
Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France. Electronic address: naghamkhanafer@hotmail.com.
2
Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France.
3
Pierre and Marie Curie University, Paris, France; National Reference Laboratory for C. difficile, Saint Antoine Hospital, Paris, France.
4
Sanofi Pasteur, Lyon, France.
5
Laboratory of Micro-biology Est, Hospices Civils de Lyon, Bron, France
6
Groupement Hospitalier Edouard Herriot, Hos- pices Civils de Lyon, Lyon, France

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Clostridium difficile infection; Predictors; Risk factors

PMID:
28279859
DOI:
10.1016/j.anaerobe.2017.03.003
[Indexed for MEDLINE]

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