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

Details

• Alternative Title:
  Open Forum Infect Dis
• Personal Author:
  Guh, Alice Y ; Adkins, Susan Hocevar ; Li, Qunna ; Bulens, Sandra N ; Farley, Monica M ; Smith, Zirka ; Holzbauer, Stacy M ; Whitten, Tory ; Phipps, Erin C ; Hancock, Emily B ; Dumyati, Ghinwa ; Concannon, Cathleen ; Kainer, Marion A ; Rue, Brenda ; Lyons, Carol ; Olson, Danyel M ; Wilson, Lucy ; Perlmutter, Rebecca ; Winston, Lisa G ; Parker, Erin ; Bamberg, Wendy ; Beldavs, Zintars G ; Ocampo, Valerie ; Karlsson, Maria ; Gerding, Dale N ; McDonald, L Clifford
• Description:
  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.
  
  
• Subjects:
  Community-associated Clostridium Difficile Infection Editor's Choice Major Articles
• Source:
  Open Forum Infect Dis. 2017; 4(4).
• Pubmed ID:
  29732377
• Pubmed Central ID:
  PMC5903408
• Document Type:
  Journal Article
• Volume:
  4
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e8fe53464a4e75a7cb3c9bb4e9c588d82d4ce1541e4ffd77109115993588c74c
• Download URL:
  https://stacks.cdc.gov/view/cdc/55269/cdc_55269_DS1.pdf
• File Type:
  [PDF - 168.88 KB ]