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Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study
Journal article   Open access   Peer reviewed

Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study

Jennifer L Kuntz, Elizabeth A Chrischilles, Jane F Pendergast, Loreen A Herwaldt and Philip M Polgreen
BMC infectious diseases, Vol.11(1), pp.194-194
07/15/2011
DOI: 10.1186/1471-2334-11-194
PMCID: PMC3154181
PMID: 21762504
url
https://doi.org/10.1186/1471-2334-11-194View
Published (Version of record) Open Access

Abstract

Clostridium difficile is the most common cause of nosocomial infectious diarrhea in the United States. However, recent reports have documented that C. difficile infections (CDIs) are occurring among patients without traditional risk factors. The purpose of this study was to examine the epidemiology of CA-CDI, by estimating the incidence of CA-CDI and HA-CDI, identifying patient-related risk factors for CA-CDI, and describing adverse health outcomes of CA-CDI. We conducted a population-based, retrospective, nested, case-control study within the University of Iowa Wellmark Data Repository from January 2004 to December 2007. We identified persons with CDI, determined whether infection was community-associated (CA) or hospital-acquired (HA), and calculated incidence rates. We collected demographic, clinical, and pharmacologic information for CA-CDI cases and controls (i.e., persons without CDI). We used conditional logistic regression to estimate the odds ratios (ORs) for potential risk factors for CA-CDI. The incidence rates for CA-CDI and HA-CDI were 11.16 and 12.1 cases per 100,000 person-years, respectively. CA-CDI cases were more likely than controls to receive antimicrobials (adjusted OR, 6.09 [95% CI 4.59-8.08]) and gastric acid suppressants (adjusted OR, 2.30 [95% CI 1.56-3.39]) in the 180 days before diagnosis. Controlling for other covariates, increased risk for CA-CDI was associated with use of beta-lactam/beta-lactamase inhibitors, cephalosporins, clindamycin, fluoroquinolones, macrolides, and penicillins. However, 27% of CA-CDI cases did not receive antimicrobials in the 180 days before their diagnoses, and 17% did not have any traditional risk factors for CDI. Our study documented that the epidemiology of CDI is changing, with CA-CDI occurring in populations not traditionally considered "high-risk" for the disease. Clinicians should consider this diagnosis and obtain appropriate diagnostic testing for outpatients with persistent or severe diarrhea who have even remote antimicrobial exposure.
 Enterocolitis, Pseudomembranous - epidemiology Community-Acquired Infections - epidemiology Humans Middle Aged Risk Factors Anti-Infective Agents - therapeutic use Logistic Models Male Clostridium difficile - isolation & purification Cross Infection - drug therapy Incidence Enterocolitis, Pseudomembranous - drug therapy Community-Acquired Infections - drug therapy Cross Infection - microbiology Adolescent Adult Female Aged Retrospective Studies Odds Ratio Community-Acquired Infections - microbiology Cross Infection - epidemiology

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