Prevention of Recurrent Thrombotic Events in Children with Central Venous Catheter-Associated Venous Thrombosis

Blood ◽  
2021 ◽  
Author(s):  
Helen Havens Clark ◽  
Lance Ballester ◽  
Hilary B Whitworth ◽  
Leslie Raffini ◽  
Char Witmer
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Venous Catheter ◽  
Significant Risk Factor ◽  
Bleeding Risk ◽  
Secondary Prophylaxis ◽  
Central Venous ◽  
Full Dose ◽  
Increased Risk ◽  
Recurrent Vte

Central venous catheters (CVC) are the most significant risk factor for pediatric venous thromboembolism (VTE). After an index CVC-associated VTE (CVC-VTE), the role of secondary prophylaxis for subsequent CVC placement is uncertain. Aims of this single center retrospective study were to evaluate the efficacy of secondary prophylaxis for patients with a prior CVC-VTE and identify risk factors associated with recurrent VTE in patients less than 19 years with an index CVC-VTE between 2003 and 2013. Data collection included clinical and demographic factors, subsequent CVC placement, secondary prophylaxis strategy, recurrent VTE, and bleeding. Risk factors for recurrence and effectiveness of secondary prophylaxis were evaluated using survival and binomial models. Among 373 patients with an index CVC-VTE, 239 (64.1%) had subsequent CVC placement. 17.4% (65/373) of patients had recurrent VTE, 90.8% (59/65) were CVC-associated. On multivariable survival analysis, each additional CVC (HR 12.00; 95% CI 2.78 - 51.91), congenital heart disease (HR 3.70; 95% CI 1.97 - 6.95), and total parenteral nutrition dependence (HR 4.02; 95% CI 2.23 - 7.28) were associated with an increased hazard of recurrence. Full dose anticoagulation for secondary prophylaxis was associated with decreased odds of recurrent CVC-VTE (OR 0.35; 95% CI 0.19 - 0.65) but not prophylactic dosing (OR 0.61; 95% CI 0.28 - 1.30). Only 1.3% of CVCs experienced major bleeding with prophylactic or full dose anticoagulation. In summary, children with CVC-VTE are at increased risk for recurrent VTE. Secondary prophylaxis with full dose anticoagulation was associated with a 65% reduction in odds of thrombotic events.

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

Blood Products: A Significant Risk Factor for Long-Term Catheter-Related Bloodstream Infections in Cancer Patients

2001 ◽  
Vol 22 (03) ◽  
pp. 165-166 ◽  
Author(s):  
Hend A. Hanna ◽  
Issam Raad
Keyword(s):  
Risk Factor ◽  
Cancer Patients ◽  
Randomized Study ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Significant Risk Factor ◽  
Recent Analysis ◽  
Blood Products ◽  
Central Venous

Abstract Data obtained from a previous prospective randomized study in cancer patients conducted at our institution were analyzed to investigate risk factors for catheter-related (CR) bloodstream infections (BSIs). Our recent analysis showed that the administration of blood products through central venous catheters was a risk factor for CR BSI, whereas thrombocytopenia during catheterization may have provided protection against CR BSI, as did central venous catheter insertion under maximal sterile barrier precautions.

scholarly journals Post-Anticoagulation Cessation D-Dimer Testing and VTE Recurrence in Real-World Australian Audit

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1227-1227
Author(s):  
Julie Wang ◽  
Rowena Brook ◽  
Alison Slocombe ◽  
Lisa Hong ◽  
Prahlad Ho
Keyword(s):  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Recurrent Vte ◽  
Residual Thrombus ◽  
Repeat Imaging ◽  
D Dimer

Abstract Aim Elevated D-dimer post-anticoagulation cessation is a recognised risk factor for recurrent venous thromboembolic events (VTE). In particular, raised D-dimer post cessation has been associated with increased risk of recurrence in unprovoked major VTE. Currently in Australia, D-dimer has not been widely used in practice to stratify the risk of VTE recurrence. This study aims to retrospectively analyse the effect of routine D-dimer testing and it's association with VTE recurrence. Methods A retrospective evaluation was performed on 1024 patients with a diagnosis of VTE at a tertiary hospital in Australia between January 2013 and December 2016. Data collected included demographics, results and timing of D-dimer testing and serial imaging results. Results 1024 patients were reviewed with a total median follow up of 12 months (range 0-59 months). D-dimer was tested in 189 patients (18.5%) within 90 days after cessation of anticoagulation. Of these patients, median age was 58 (18-92) and 55.3% (n=105) were female. 33.3% (n=63) had isolated distal deep vein thrombosis (IDDVT), 66.3% (n=126) had above knee DVT (AKDVT)/pulmonary embolus (PE), 54.5% (n=103) of VTE were provoked. Abnormal post cessation D-dimer (>500) was found in 72 patients (37.9%). Of these, 25 patients were restarted on anticoagulation; one had recurrent VTE whilst on low dose apixaban 2.5mg BD and one had recurrence after cessation of anticoagulation at a later date. Patients with elevated D-dimer post cessation had a higher rate of recurrence with the highest risk in patients with D-dimer >1000 (RR 7.38, p=<0.01) outlined in Table 1. Of the 164 patients with post cessation D-dimer testing who remained off anticoagulation there were a total of 24 (12.6%) episodes of recurrent VTE. Elevated D-dimer post anticoagulation cessation was a significant risk factor for recurrence in both provoked VTE (RR 4.21, p=0.01) and unprovoked VTE cohorts (RR 4.55, p=0.008) outlined in Table 2. When provoked VTE were sub-categorised, raised D-dimer demonstrated the most statistical significance in VTE provoked by travel (RR 13.5 p=0.06). Of the patients with post anticoagulation cessation D-dimer testing 170 patients (89.9%) had repeat imaging to assess for residual thrombus. In the subgroup of patients with no residual thrombus, elevated D-dimer was a significant risk factor for VTE recurrence (RR 6.4, p=<0.01). Patients with normal D-dimer and no residual thrombus had the lowest rate of recurrence 5.4% (n=4) see Table 3. When stratified by type of VTE, elevated D-dimer post anticoagulation cessation was significantly related to risk for recurrence in the overall IDDVT sub-cohort (RR 4.09, p=0.007). This was not significant for the AKDVT/PE sub cohort (RR 3.24, p=0.079). However, for patients with unprovoked AKDVT or PE, having D-dimer tested post anticoagulation, regardless of result, was associated with lower rates of VTE recurrence RR 0.30 (p=0.02) compared to those who had no D-dimer testing as part of follow-up. Conclusion Post treatment D-dimer testing may have a clinical role in stratifying the risk of VTE recurrence along with repeat imaging to detect residual thrombus. Elevated D-dimer post anticoagulation cessation is associated with increased risk of VTE recurrence for both provoked and unprovoked VTE with highest risk in patients with D-dimer >1000. Patients with no residual thrombus and a negative D-dimer post anticoagulation cessation had the lowest rate of recurrence. In the subgroup of patients with provoked VTE and IDDVT a positive D-dimer post cessation was associated with 4.21 and 4.09 relative risk of recurrence respectively, suggesting that the role of D-dimer testing can be extended to these subpopulations. Interestingly, in patients with unprovoked AKDVT or PE, having post-cessation D-dimer testing performed, regardless of result, was associated with a significantly lower rate of VTE recurrence compared to patients without D-dimer testing, which may be related to specialist review and recommencement of anticoagulation in high-risk patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prevalence of pulmonary tuberculosis in Karachi juvenile jail, Pakistan

2003 ◽  
Vol 9 (4) ◽  
pp. 667-674
Author(s):  
S. A. Shah ◽  
S. A. Mujeeb ◽  
A. Mirza ◽  
K. G. Nabi ◽  
Q. Siddiqui
Keyword(s):  
Risk Factors ◽  
Positive Family History ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Treatment Programme ◽  
Tb Treatment ◽  
Increased Risk ◽  
History Of ◽  
Poor Ventilation ◽  
General Community

Jailinmates may be at increased risk of contracting tuberculosis [TB]. We studied 386 detainees [mean age 17.7 years] in Karachi juvenile jail to determine the prevalence of TB and possible risk factors for contracting TB. We found a 3.9% prevalence of TB among the inmates, significantly higher than the estimated 1.1% prevalence in the general population of Pakistan. Positive family history of TB was a significant risk factor for TB. Poor adherence of previously diagnosed patients to anti-TB treatment was found. Our study highlights the vulnerability of inmates to TB owing to the presence of highly infectious cases, along with environmental conditions such as overcrowding and poor ventilation. This study strongly indicates the need for an effective treatment programme in the jails as well in the general community

scholarly journals Parvovirus Enteritis and Other Risk Factors Associated With Persistent Gastrointestinal Signs in Dogs Later in Life: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Kanae Takada ◽  
Anne M. Flemming ◽  
Maarten J. Voordouw ◽  
Anthony P. Carr
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Health Problems ◽  
Organ Systems ◽  
Increased Risk

Abstract Background: Parvoviral enteritis is a viral gastrointestinal (GI) infection of dogs. Recovery from PE has been associated with persistent GI signs. The objectives of this study were: (i) To determine whether dogs that have recovered from PE (post-parvo dogs) had an increased risk of persistent GI signs compared to uninfected controls. (ii) To investigate the lifestyle and clinicopathologic factors that are associated with persistent GI signs in post-parvo dogs. Methods: Eighty-six post-parvo dogs and 52 age-matched control dogs were enrolled in this retrospective cohort study. The owners were interviewed about the health and habits of their dogs using a questionnaire. We used logistic regression to test whether parvovirus enteritis and other risk factors are associated with general health problems in all dogs and with persistent GI signs in post-parvo dogs.Results: The prevalence of persistent GI signs was significantly higher in post-parvo dogs compared to control dogs (57% vs 25%, P < 0.001). Markers of disease severity such as neutropenia, low body temperature, and treatment with an antiemetic medication (metoclopramide) were significant risk factors for persistent GI signs in post-parvo dogs. Persistent GI signs in post-parvo dogs was a risk factor for health problems in other organ systems.Conclusions: Parvovirus enteritis is a significant risk factor for persistent GI signs in dogs highlighting the importance of prevention. The risk factors identified in the present study may guide future investigations on the mechanisms that link parvovirus enteritis to chronic health problems in dogs.

scholarly journals Predictors of a Successful Bipolar Radiofrequency Endometrial Ablation

2019 ◽  
Vol 79 (03) ◽  
pp. 286-292
Author(s):  
Lilly Eisele ◽  
Lea Köchli ◽  
Patricia Städele ◽  
JoEllen Welter ◽  
Maja Fehr-Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Multivariate Analyses ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Endometrial Ablation ◽  
Bipolar Radiofrequency ◽  
Increased Risk ◽  
Intramural Fibroids

Abstract Introduction The studyʼs objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method. Materials and Methods 195 women who were treated with bipolar radiofrequency endometrial ablation between 01/2009 and 06/2016 were included in this prospective cohort study. Postoperative data from 187 women were collected at a median of 17.5 months (IQR 4.5–34.9; 1–82). Multivariate analyses of risk factors were performed. Success was defined as amenorrhoea or spotting. Results Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity 2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median BMI 23.5 kg/m2 (IQR 21–27). 30 patients (19.5%) had intramural masses that could be measured with ultrasound. Postoperative success rate was 86.1%. 10 patients (5%) had a hysterectomy postoperatively – 6 for heavy bleeding, 3 due to prolapse, and 1 due to dysmenorrhoea. Multivariate analyses showed the presence of intramural masses in women < 45 years was a significant risk factor for therapeutic failure (p = 0.033; 95% CI 1.08–12.57), with an increased risk of hysterectomy (OR 7.9, 95% CI 1.2–52.7, p = 0.033). Conclusion Bipolar radio frequency endometrial ablation was highly successful in the absence of an intramural mass (88%). Even smaller intramural fibroids (DD: adenomyomas of a median of 15 mm) reduce the success rate (76%), which is why preoperative ultrasound is recommended. In the presence of intramural masses, the risk of a hysterectomy for women < 45 years increases eightfold.

scholarly journals 2430. Comorbidity and Severity of Illness Risk Adjustment for Hospital-Onset Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S840-S840
Author(s):  
Stephanie Cabral ◽  
Gita Nadimpalli ◽  
Kerri Thom ◽  
Surbhi Leekha ◽  
Lisa Harris ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Eligible Patient ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Significant Risk Factor ◽  
Patient Admissions ◽  
Increased Risk ◽  
Binomial Regression

Abstract Background Hospital-onset C. difficile infection (HO-CDI) rates are publicly reported. However, patient-level risk factors are not included in the current risk adjustment methodology, and the knowledge as to which risk factors to include is incomplete. This study aimed to determine whether electronically-available comorbidities and laboratory indicators of severity of illness are risk factors for HO-CDI. Methods We performed a retrospective cohort study of all adult patients admitted to three hospitals (one academic, two community) in Baltimore, Maryland between January 1, 2016 and January 1, 2018. Information extracted from electronic medical records included demographics, ICD-10 codes, laboratory results within 24 hours of admission (i.e., hematocrit, hemoglobin, platelet count, leukocytes, BUN, CO2, creatinine, glucose, sodium, and potassium), medication administration (i.e., antibiotic and antacid use), and C. difficile test result. Comorbid conditions were assessed by the Elixhauser Comorbidity Index components. HO-CDI was defined by positive laboratory test > 3 days after admission. Potential risk factors for HO-CDI were assessed using bivariate log binomial regression. Multivariable log binomial regression was conducted using significant (P < 0.1) covariates. Results At hospital 1 (academic), 314 of the 48,057 (0.65%) eligible patient admissions had HO- CDI; 41 of the 8,791 (0.47%) and 75 of the 29,211 (0.26%) of patient admissions at community hospitals 2 and 3, respectively, had HO-CDI. In multivariable analysis, Elixhauser Score was a significant risk factor for HO-CDI at all hospitals when controlling for antibiotic and antacid use; for every one-point increase in Elixhauser Score, there was an increased risk of HO-CDI of 1.27 (95% CI: 1.21, 1.32) at hospital 1, 1.38 (95% CI: 1.24, 1.54) at hospital 2, and 1.28 (95% CI: 1.10, 1.31) at hospital 3. Table 1 shows significant risk factors for HO-CDI for each hospital. When individual comorbidities were assessed in the regression analysis, fluid and electrolyte disorders were a significant risk factor for HO-CDI for all hospitals. Conclusion Laboratory values upon admission and electronically available patient comorbidities are important risk factors for HO-CDI and should be considered for future risk adjustment. Disclosures All authors: No reported disclosures.

scholarly journals Risk Factors Related to Peripherally Inserted Central Venous Catheter Nonselective Removal in Neonates

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Xiaohe Yu ◽  
Shaojie Yue ◽  
Mingjie Wang ◽  
Chuanding Cao ◽  
Zhengchang Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Neonatal Intensive Care ◽  
Insertion Site ◽  
Venous Catheter ◽  
Central Venous ◽  
Patient Demographics ◽  
Increased Risk ◽  
Catheter Complications ◽  
Tip Position

We aimed to investigate the incidence and risk factors associated with nonselective removal of peripherally inserted central venous catheter (PICC) in neonates. In this prospective cohort study, neonates who underwent PICC placement at neonatal intensive care units (NICUs) in China from October 2012 to November 2015 were included. The patient demographics, catheter characteristics, catheter duration, PICC insertion site, indication for PICC insertion, infuscate composition, PICC tip location, and catheter complications were recorded in a computerized database. Risk factors for nonselective removal were analyzed. A total of 497 PICCs were placed in 496 neonates. Nonselective removal occurred in 9.3% of PICCs during 10,540 catheter-days (4.6 nonselective removals per 1,000 catheter-days). These included occlusion (3%), infection (1.4%), leakage (2.0%), phlebitis (0.6%), displacement (1%), pleural effusion(0.6%), and breaks (0.6%). Noncentral tip position was independently associated with an increased risk of nonselective removal (odds ratio 2.621; 95% confidence interval, 1.258-5.461) after adjusting for gestational age, sex, birth weight, and PICC dwell time. No significant differences in the rate of complications occurred between silastic and polyurethane PICC or different insertion sites. Noncentral PICC tip position was the only independent risk factor for nonselective removal of PICC.

scholarly journals Central venous catheter-associated thrombosis in children with congenital hyperinsulinism

2019 ◽  
Vol 2019 ◽  
Author(s):  
Daphne Yau ◽  
Maria Salomon-Estebanez ◽  
Amish Chinoy ◽  
John Grainger ◽  
Ross J Craigie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Significant Proportion ◽  
Significant Risk ◽  
Venous Catheter ◽  
Bleeding Complications ◽  
Compound Heterozygous ◽  
Congenital Hyperinsulinism ◽  
List Type ◽  
Central Venous

Summary Congenital hyperinsulinism (CHI) is an important cause of severe hypoglycaemia in infancy. To correct hypoglycaemia, high concentrations of dextrose are often required through a central venous catheter (CVC) with consequent risk of thrombosis. We describe a series of six cases of CHI due to varying aetiologies from our centre requiring CVC for the management of hypoglycaemia, who developed thrombosis in association with CVC. We subsequently analysed the incidence and risk factors for CVC-associated thrombosis, as well as the outcomes of enoxaparin prophylaxis. The six cases occurred over a 3-year period; we identified an additional 27 patients with CHI who required CVC insertion during this period (n = 33 total), and a separate cohort of patients with CHI and CVC who received enoxaparin prophylaxis (n = 7). The incidence of CVC-associated thrombosis was 18% (6/33) over the 3 years, a rate of 4.2 thromboses/1000 CVC days. There was no difference in the frequency of genetic mutations or focal CHI in those that developed thromboses. However, compound heterozygous/homozygous potassium ATP channel mutations correlated with thrombosis (R2 = 0.40, P = 0.001). No difference was observed in CVC duration, high concentration dextrose or glucagon infused through the CVC. In patients receiving enoxaparin prophylaxis, none developed thrombosis or bleeding complications. The characteristics of these patients did not differ significantly from those with thrombosis not on prophylaxis. We therefore conclude that CVC-associated thrombosis can occur in a significant proportion (18%) of patients with CHI, particularly in severe CHI, for which anticoagulant prophylaxis may be indicated. Learning points: CVC insertion is one of the most significant risk factors for thrombosis in the paediatric population. Risk factors for CVC-associated thrombosis include increased duration of CVC placement, malpositioning and infusion of blood products. To our knowledge, this is the first study to evaluate CVC-associated thrombosis in patients with congenital hyperinsulinism (CHI). The incidence of CVC-associated thrombosis development is significant (18%) in CHI patients and higher compared to other neonates with CVC. CHI severity may be a risk factor for thrombosis development. Although effective prophylaxis for CVC-associated thrombosis in infancy is yet to be established, our preliminary experience suggests the safety and efficacy of enoxoaparin prophylaxis in this population and requires on-going evaluation.

scholarly journals Risk factors for Clostridium difficile infection in pediatric inpatients: A meta-analysis and systematic review

2019 ◽  
Vol 40 (4) ◽  
pp. 420-426 ◽  
Author(s):  
Scott Anjewierden ◽  
Zheyi Han ◽  
Charles B. Foster ◽  
Chaitanya Pant ◽  
Abhishek Deshpande
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Factor ◽  
Meta Analysis ◽  
Significant Risk ◽  
Female Gender ◽  
Significant Risk Factor ◽  
Antibiotic Exposure ◽  
H2 Receptor Antagonist ◽  
Increased Risk

AbstractObjective:To summarize risk factors for Clostridioides (formerly Clostridium) difficile infection (CDI) in hospitalized pediatric patients as determined by previous observational studies.Design:Meta-analysis and systematic review.Patients:Studies evaluating risk factors for CDI in pediatric inpatients were eligible for inclusion.Method:We systematically searched MEDLINE, Web of Science, Scopus, and EMBASE for subject headings and text words related to CDI and pediatrics from 1975 to 2017. Two of the investigators independently screened studies, extracted and compiled data, assessed study quality, and performed the meta-analysis.Results:Of the 2,033 articles screened, 14 studies reporting 10,531,669 children met the inclusion criteria. Prior antibiotic exposure (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31–3.52) and proton pump inhibitor (PPI) use (OR, 1.33; 95% CI, 1.07–1.64) were associated with an increased risk of CDI in children. Subgroup analyses using studies reporting only adjusted results suggested that prior antibiotic exposure is not a significant risk factor for CDI. H2 receptor antagonist (H2RA) use (OR, 1.36; 95% CI, 0.31–5.98) and that female gender (OR, 0.87; 95% CI, 0.74–1.03) did not play a significant role as a risk factor for developing CDI.Conclusion:Prior antibiotic exposure appears to be an important risk factor for CDI based on the combined analysis but not significant using adjusted studies. PPI use was associated with an increased risk of CDI. Judicious and appropriate use of antibiotics and PPIs may help reduce the risk of CDI in this vulnerable population.

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