Increasing length of stay, exposure to multiple classes of antibiotics, use of opioids and cirrhosis are all independently associated with an increased risk for hospital-onset Clostridioides difficile infection, or CDI, in asymptomatic colonized patients, but age is not, according to findings from a retrospective cohort study.
According to Yves Longtin, MD, chair of infection prevention and control at Jewish General Hospital in Montreal and associate professor of medicine at McGill University, and colleagues, “colonized individuals are at risk of progressing to CDI, but the factors that trigger progression to CDI are poorly understood.”
For their study, Longtin and colleagues assessed 513 patients colonized with C. difficile at the Quebec Heart and Lung Institute between November 2013 and January 2017, 7.6% of whom developed hospital-onset CDI. The 30-day attributable mortality was 15%.
The researchers found that hospital-onset CDI was independently associated with an increased length of stay (adjusted OR per day = 1.03; P = .006), exposure to multiple classes of antibiotics (aOR per class = 1.45; P = .02), use of opioids (aOR = 2.78; P = .007) and cirrhosis (aOR = 5.49; P = .008). The use of laxatives was associated with a lower risk for CDI (aOR = 0.36; P = .01), according to the findings.
Longtin and colleagues also assessed the impact of specific antibiotics on CDI risk and found that beta-lactam with beta-lactamase inhibitors (OR = 3.65; P < .001), first-generation cephalosporins (OR = 2.38; P = .03) and carbapenems (OR = 2.44; P = .03) demonstrated the greatest risk for hospital-onset CDI.
Patient age, use of proton pump inhibitors and the administration of primary prophylaxis were not significant predictors of hospital-onset CDI, the researchers said.
“The lack of association between age and the risk of CDI among colonized patients is striking considering that age is amongst the strongest predictors for CDI,” Longtin and colleagues wrote. “This finding suggests that age may be associated with an increased risk of CDI through a greater susceptibility to colonization rather than an increased risk of progression to CDI once colonization has occurred, although studies on this topic have produced conflicting results.”
Although the findings demonstrated several predictive factors associated with hospital-onset CDI among colonized patients, Poirier and colleagues noted that further investigation is needed to determine whether “modifying these variables could decrease the risk of CDI.” – Marley Ghizzone
Disclosures: Longtin reports receiving research funding from Becton Dickinson and Merck, and research funding and personal fees from Gojo. Please see the study for all other authors’ relevant financial disclosures.