Predictors of Clostridioidesdifficile Infection among Asymptomatic Colonized Patients: A Retrospective Cohort Study

BACKGROUND: Asymptomatic patients colonized with Clostridioides difficile are at risk of developing C. difficile infection (CDI), but factors associated with disease onset are poorly understood. Our aims were to identify predictors of hospital-onset CDI (HO-CDI) among colonized patients, and explore the potential benefit of primary prophylaxis to prevent CDI. METHODS: Retrospective cohort study in a tertiary academic institution. Colonized patients were identified by detecting the tcdB gene by PCR on a rectal swab. Univariate and multivariate logistic regression analyses were used to identify predictors of HO-CDI. RESULTS: 19,112 patients were screened, 960 (5%) colonized patients were identified and 513 met the inclusion criteria. Overall, 39 (7.6%) developed a HO-CDI, with a 30-day attributable mortality of 15%. An increasing length of stay (adjusted odds ratio [aOR] per day, 1.03; p=0.006), exposure to multiple classes of antibiotics (aOR per class, 1.45; p=0.02), use of opioids (aOR, 2.78; p=0.007), and cirrhosis (aOR 5.49; p=0.008), were independently associated with an increased risk of HO-CDI, whereas the use of laxatives was associated with a lower risk of CDI (aOR 0.36; p=0.01). Among the antimicrobials, B-lactam with B-lactamase inhibitors (OR 3.65; p0.001), first generation cephalosporins (OR 2.38; p=0.03), and carbapenems (OR 2.44; p=0.03) correlated with the greatest risk of HO-CDI. By contrast, patient age, proton pump inhibitors and the use of primary prophylaxis were not significant predictors of HO-CDI. CONCLUSIONS: This study identifies several factors that are associated with CDI among colonized patients. Whether modifying these variables could decrease the risk of CDI should be investigated.
Auteurs (Zotero)
Poirier, Dominic; Gervais, Philippe; Fuchs, Margit; Roussy, Jean-Francois; Paquet-Bolduc, Bianka; Trottier, Sylvie; Longtin, Jean; Loo, Vivian G.; Longtin, Yves
Date de publication (Zotero)
juillet, 2019