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Open Forum Infect Dis. 2017 Oct 26;4(4):ofx171. doi: 10.1093/ofid/ofx171. eCollection 2017 Fall.

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study.

Author information

1
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Emory University Department of Medicine, Atlanta, Georgia.
3
Georgia Emerging Infections Program, Decatur, Georgia.
4
Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.
5
Atlanta Research and Education Foundation, Decatur, Georgia.
6
Minnesota Department of Health, St Paul, Minnesota.
7
Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia.
8
University of New Mexico, New Mexico Emerging Infections Program, Albuquerque, New Mexico.
9
New York Emerging Infections Program and University of Rochester Medical Center, Rochester, New York.
10
Tennessee Department of Health, Nashville, Tennessee.
11
Yale School of Public Health, Connecticut Emerging Infections Program, New Haven, Connecticut.
12
Maryland Department of Health and Mental Hygiene, Baltimore, Maryland.
13
University of California, San Francisco, School of Medicine, San Francisco, California.
14
California Emerging Infections Program, Oakland, California.
15
Colorado Department of Public Health and Environment, Denver, Colorado.
16
Oregon Health Authority, Portland, Oregon.
17
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
18
Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois.

Abstract

Background:

An increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.

Methods:

We enrolled participants from 10 US sites during October 2014-March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.

Results:

Of 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure-that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13-321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01-311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77-340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76-340.05),-emergency department visit (AmOR, 17.37; 95% CI, 1.99-151.22), white race (AmOR 7.67; 95% CI, 2.34-25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20-19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24-118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27-20.79) were associated with CA-CDI.

Conclusions:

Antibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.

KEYWORDS:

community-associated Clostridium difficile infection

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