Risk factors for development of initial Clostridioides difficile infection

Abstract Background In contrast to Europe and North America, little is known about Clostridioides difficile infection (CDI) in Latin America, especially about risk factors, mortality, and healthcare utilization. Methods We conducted a retrospective, case–control study at eight hospital centers in Brazil, Mexico, Argentina, and Chile. Hospital databases and medical records were used to identify nosocomial CDI cases from January 1, 2014 to December 31, 2017. CDI cases were patients with diarrhea and a positive CDI testing ≥72 hours after hospital admission. Two controls with no CDI diagnosis and diarrhea were matched to each CDI case and were required to (1) have a length of hospital stay (LOS) ≥ 3 days, (2) be admitted ±14 days from the case, and (3) share the same ward. Risk factors associated with CDI were assessed by conditional logistic regression. Mortality and healthcare utilization were compared between cases and controls. Results A total of 1,443 patients (≥18 years old) who met eligibility criteria were selected (481 cases and 962 controls). Comparing cases to controls, the mean age and gender representation were similar (age: 58.7 vs. 56.7 years, P = 0.269; male: 56.3% vs. 53.4%, P = 0.293), but comorbidity was higher (mean Charlson Comorbidity index: 4.3 vs. 3.6, p Conclusion Antibiotic exposure, existing medical conditions, and recent hospital admission are CDI major risk factors in Latin America. CDI also increased in-hospital death risk and LOS. These findings are consistent with published literature in developed countries. Disclosures All authors: No reported disclosures.

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Burden and risk factors for inappropriate Clostridioides Difficile infection testing among hospitalized patients

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2020.115283 ◽

2021 ◽

Vol 99 (4) ◽

pp. 115283

Author(s):

Ellen Axenfeld ◽

William G. Greendyke ◽

Jianhua Li ◽

Daniel A. Green ◽

Susan Whittier ◽

...

Keyword(s):

Risk Factors ◽

Hospitalized Patients ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

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Hospital acquired Clostridioides difficile infection and risk factors for severity in a university hospital: A prospective study

American Journal of Infection Control ◽

10.1016/j.ajic.2020.05.042 ◽

2020 ◽

Vol 48 (12) ◽

pp. 1426-1430

Author(s):

Hüseyin Bilgin ◽

Elvan Sayın ◽

Hande Perk Gürün ◽

Elif Tükenmez-Tigen ◽

Nurver Ülger Toprak ◽

...

Keyword(s):

Risk Factors ◽

Prospective Study ◽

University Hospital ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

A Prospective Study ◽

Hospital Acquired

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Risk Factors for BI/NAP1/027 Clostridioides difficile Infections and Clinical Outcomes Compared With Non-NAP1 Strains

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz433 ◽

2019 ◽

Vol 6 (12) ◽

Author(s):

Nandita S Mani ◽

John B Lynch ◽

Ferric C Fang ◽

Jeannie D Chan

Keyword(s):

Risk Factors ◽

Proton Pump Inhibitor ◽

Clinical Outcomes ◽

Case Control ◽

Nursing Facilities ◽

Single Center ◽

Retrospective Case ◽

Skilled Nursing ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

Abstract We aim to describe the characteristics, risk factors, and clinical outcomes associated with NAP1 strain Clostridioides difficile infection (CDI) in this single-center, retrospective, case–control (1:1) study. We found that the NAP1 strain accounted for 19.7% of CDI, and risk factors for acquisition included residence in skilled nursing facilities, previous CDI, and proton pump inhibitor use.

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Clostridioides difficile infection in patients with end stage renal disease. Is it preventable?

Przeglad Epidemiologiczny ◽

10.32394/pe.74.02 ◽

2020 ◽

pp. 11-21

Keyword(s):

Risk Factors ◽

Renal Disease ◽

End Stage Renal Disease ◽

Significant Risk ◽

Medical Personnel ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Stage Renal Disease ◽

End Stage ◽

Healthcare Associated

Clostridioides difficile infection (CDI) is a leading cause of a healthcare-associated diarrhea worldwide. Recently, an increased number of new cases and growing mortality due to CDI have been observed. Patients suffering from end-stage renal disease (ESRD) are most exposed to CDI. It has been proven that CDI in patients receiving renal replacement therapy (RRT) significantly increases mortality, prolongs hospitalization and increases the cost of treatment. Important risk factors of CDI in ERSD patients include hospitalization or stay in an intensive care unit in the last 90 days, HIV infection, bacteremia, prolonged antibiotic therapy and hypoalbuminemia. Cirrhosis, age over 65 years, hypoalbuminemia, longer hospitalization time and use of antibiotics are significant risk factors of death. Effective methods of preventing CDI include hand hygiene with soap and water, isolation of infected patients in a private room with a dedicated toilet, the use of masks, gloves, disinfection of the environment and systematic education and control of medical personnel, as well as rational antibiotic policy. In addition, it is important to avoid antibiotics with a proven risk of CDI, caution use of proton pump inhibitors (PPI) and H2 receptor antagonists. It is also important in the prevention of CDI in people with ERSD, to apply a fast diagnostic since the onset of the first symptoms. The use of probiotics and bile acids in the primary prevention of CDI requires further research. It seems that knowledge of these factors and methods of prevention will significantly reduce morbidity and mortality due to CDI.

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GRADING prognostic factors for severe and recurrent Clostridioides difficile infection: expected and unexpected findings. A systematic review.

10.1101/2021.06.22.21259313 ◽

2021 ◽

Author(s):

Tessel Meike van Rossen ◽

Rogier E. Ooijevaar ◽

Christina M.J.E. Vandenbroucke-Grauls ◽

Olaf M. Dekkers ◽

Ed J. Kuijper ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Prognostic Factors ◽

Laboratory Data ◽

Final Analysis ◽

Cochrane Library ◽

Case Control Studies ◽

Clostridioides Difficile ◽

Increased Risk ◽

Clostridioides Difficile Infection

Background Clostridioides difficile infection (CDI), its subsequent recurrences (rCDI), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Treatment consists of oral antibiotics. Fidaxomicin, bezlotoxumab and fecal microbiota transplantion (FMT) reduce the number of recurrences compared to vancomycin, but are more costly. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices. Objectives In this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI. Methods PubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. Study selection was performed by two independent reviewers on the basis of predefined selection criteria; conflicts were resolved by consensus. Cohort and case-control studies providing an analysis of clinical or laboratory data to predict sCDI/rCDI in patients ≥18 years diagnosed with CDI, were included. Risk of bias was assessed with the Quality in Prognostic Research (QUIPS) tool and the quality of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, modified for prognostic studies. Overview tables of prognostic factors were constructed to assess the number of studies and the respective direction of an association (positive, negative, or no association). Results and conclusions 136 studies were included for final analysis. Higher age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were higher age, healthcare-associated CDI, prior hospitalization, PPIs started during/after CDI diagnosis and previous rCDI. Some variables that were found as risk factors for sCDI/rCDI in previous reviews were not confirmed in the current review, which can be attributed to differences in methodology. Risk stratification for sCDI/rCDI may contribute to a more personalized and optimal treatment for patients with CDI.

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