Characteristics associated with short-term risk of C. difficile infection among hospitalized patients Open Access

Kraft, Colleen S (2013)

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Clostridium difficile infection (CDI) is the most common cause of infectious healthcare-associated diarrhea. Factors associated with the short-term risk of CDI have not been evaluated. This case-control study examined patient characteristics associated with short-term risk of CDI within 14 days among hospitalized patients with multiple tests who initially test negative. Patients were defined as cases if they had initially tested negative by polymerase chain reaction (PCR) followed by a positive PCR test within 14 days. Controls were drawn from a population of patients from the same time period who had repeat testing and no positive result within 14 days of an initial negative PCR test. Each case was matched with three controls by age and days of hospitalization prior to first PCR test. Conditional logistic regression was used to assess the association between patient characteristics and antibiotic classes and short-term risk of C. difficile. Of 750 patients who had a test repeated within 14 days, 30 acquired C. difficile.There was a trend for patients with recent gastrointestinal procedure (odds ratio [OR] 2.41, 95% confidence interval [CI] 0.84, 6.88) for short-term acquisition of CDI. Cases had a higher proportion of recent intravenous vancomycin use within 8 weeks prior to first PCR test (OR 3.38, 95% CI 1.34, 8.49). Controls had a higher proportion of recent antiviral use (OR 0.30, 95% CI 0.11, 0.83) as compared to cases. Only 4.0% (30/750) of this study population had short-term acquisition of C. difficile and 1.3% (10/750) of the short-term cases of CDI were detected within 7 days. The association with previous intravenous vancomycin use previously has not been described in patients with short-term CDI. The practical implications for this in terms of repeated testing may include eliciting this antibiotic history when clinicians request testing earlier than 7 days in a hospitalized patient.

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