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

BMC Infectious Diseases

Research Article

Loreen A Herwaldt¹  Jennifer L Kuntz²  Jane F Pendergast³  Elizabeth A Chrischilles³  Philip M Polgreen⁴ 

[1] Carver College of Medicine, University of Iowa, Iowa City, IA, USA;Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA;College of Public Health, University of Iowa, Iowa City, IA, USA;College of Public Health, University of Iowa, Iowa City, IA, USA;Carver College of Medicine, University of Iowa, Iowa City, IA, USA;

关键词: Index Date;    Clostridium Difficile Infection;    Traditional Risk Factor;    Rabeprazole;    Oral Vancomycin;   

DOI  :  10.1186/1471-2334-11-194

 received in 2010-11-29, accepted in 2011-07-15,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundClostridium 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.MethodsWe 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.ResultsThe 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.ConclusionsOur 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.

【 授权许可】

CC BY   
© Kuntz et al; licensee BioMed Central Ltd. 2011