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

• Type of Material: Article
• Authors: Alice Y. Guh, Centers for Disease Control and Prevention; Susan Hocevar Adkins, Centers for Disease Control and Prevention; Qunna Li, Centers for Disease Control and Prevention; Sandra N. Bulens, Centers for Disease Control and Prevention; Monica Farley, Emory University; Zirka Smith, Georgia Emerging Infections Program; Stacy M. Holzbauer, Minnesota Department of Health; Tory Whitten, Minnesota Department of Health; Erin C. Phipps, University of New Mexico; Emily B. Hancock, University of New Mexico; Ghinwa Dumyati, University of Rochester; Cathleen Concannon, University of Rochester; Marion A. Kainer, Tennessee Department of Health; Brenda Rue, Tennessee Department of Health; Carol Lyons, Yale University; Danyel M. Olson, Yale University; Lucy Wilson, Maryland Department of Health and Mental Hygiene; Rebecca Perlmutter, Maryland Department of Health and Mental Hygiene; Lisa G. Winston, University of California San Francisco; Erin Parker, California Emerging Infections Program; Wendy Bamberg, Colorado Department of Public Health and Environment; Zintars G. Beldavs, Oregon Health Authority; Valerie Ocampo, Oregon Health Authority; Maria Karlsson, Centers for Disease Control and Prevention; Dale N. Gerding, Loyola University; L. Clifford McDonald, Centers for Disease Control and Prevention
• Language: English
• Date: 2017-10-26
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: Published by Oxford University Press on behalf of Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofx171
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 4
• Issue: 4
• Start Page: ofx171
• End Page: ofx171
• Grant/Funding Information: This work was supported by the Emerging Infections Program and the National Center for Emerging and Zoonotic Infectious Diseases at the US Centers for Disease Control and Prevention.
• Keywords: Infectious Diseases; TRANSMISSION; PUMP INHIBITOR USE; Science & Technology; ACQUISITION; DISEASE; LEVEL; COLONIZATION; CONTAMINATION; Life Sciences & Biomedicine; community-associated Clostridium difficile infection; ANTIBIOTIC EXPOSURE
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Immunology; Health Sciences, Public Health

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.