Background: There are inconsistent data on the risk factors for Clostridium difficile infection (CDI) in the literature. Aims: To use two C. difficile infection (CDI) case-control study groups to compare risk factors in hospitalized patients with diarrhea across different countries. Methods: A multi-center group of CDI cases/controls were identified by standardized testing from seven countries from the prior EUropean, multi-center, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhea (EUCLID). A second group of CDI cases/controls was identified from a single center in Germany [parallel study site (PSS)]. Data were extracted from the medical notes to assess CDI risk factors. Univariate analyses and multivariate logistic regression models were used to identify and compare risk factors between the two groups. Results: There were 253 and 158 cases and 921 and 584 controls in the PSS and EUCLID groups, respectively. Significant variables from univariate analyses in both groups were age ≥65, number of antibiotics (OR 1.2 for each additional antibiotic) and prior hospital admission (all p < 0.001). Congestive heart failure, diabetes, admission from assisted living or Emergency Department, proton pump inhibitors, and chronic renal disease were significant in PSS (all p < 0.05) but not EUCLID. Dementia and admitted with other bacterial diseases were significant in EUCLID (p < 0.05) but not PSS. Following multivariate analyses, age ≥ 65, number of antibiotics and prior hospital admission were consistently identified as CDI risk factors in each individual group and combined datasets. Conclusion: Our results show that the same CDI risk factors were identified across datasets. These were age ≥ 65 years, antibiotic use and prior hospital admission. Importantly, the odds of developing CDI increases with each extra antibiotic prescribed.

Cantacuzino National Medico Military Institute for Research and Development Bucharest Romania

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany

Department 1 of Internal Medicine Germany and German Centre for Infection Research University Hospital of Cologne Partner Site Bonn Cologne Cologne Germany

Department of Hospital Epidemiology and Hygiene National Center for Epidemiology Budapest Hungary

Department of Infectious Diseases National Institute of Health Dr Ricardo Jorge Lisbon Portugal

Department of Medical Microbiology 2nd Faculty of Medicine Charles University Prague and Motol University Hospital Prague Czechia

Department of Medical Microbiology Medical University of Warsaw Warsaw Poland

Department of Microbiology and Immunology in Jessenius Faculty of Medicine Martin Comenius University Bratislava Martin Slovakia

German National Reference Center for Clostridioides Difficile Institute of Medical Microbiology and Hygiene Saarland University Saarbrücken Germany

Germany National Reference Centre for Clostridiodies Clostridium difficile Institute of Medical Microbiology and Hygiene Saarland University of Medical Center Homburg Germany

Healthcare Associated Infections Research Group Leeds Teaching Hospitals NHS Trust and University of Leeds Leeds United Kingdom

Vaccine Research and Development Pfizer Inc Pearl River NY United States

Zobrazit více v PubMed

Available online at: https://www.cdc.gov/drugresistance/biggest_threats.html (accessed February 9, 2017).

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