Chronic kidney disease as a risk factor for <i>Clostridium difficile</i> infection

Eddi, Rodney; Malik, Mohammed N.; Shakov, Rada; Baddoura, Walid; Chandran, Chandra; DeBari, Vincent A.

doi:10.1111/j.1440-1797.2009.01274.x

Cited by 58 publications

(48 citation statements)

References 20 publications

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“…However, the risk may not have increased until the glomerular filtration rate decreased to 15 mL/ min and below. 21 Of the different types of severe infections associated with T2DM in acute medical wards, sepsis was the only significant risk factor associated with a hospital-acquired C. difficile infection. Sepsis tends to be more severe and hence management often involves use of multiple highdose broad spectrum antibiotics for a longer duration of time.…”

Section: Discussionmentioning

confidence: 99%

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hassan

Rahman²,

Huda³

et al. 2013

J R Coll Physicians Edinb

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Background:Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards. Methods: Our prospective cross-sectional study involved 159 patients with established type 2 diabetes mellitus admitted into acute medical wards who developed a hospital-acquired C. difficile infection. Stools were tested for C. difficile toxins using a toxin A/B kit and a toxin A kit. Clinical features, laboratory findings, types of antibiotics, and use of a proton pump inhibitor were examined for their association with the infection. Results: Thirteen subjects were positive for toxin A and one for toxin B. Using univariable analysis, we found that patients with type 2 diabetes mellitus and hospitalacquired C. difficile infection were younger (mean 53.8 years, p=0.02), had diarrhoea and abdominal pain (p=0.001) but no fever. Sepsis (p=0.02) and use of a proton pump inhibitor (p=0.01) were more commonly implicated as the cause of the infection. Of the various types of antibiotics prescribed, carbapenem (28.6% vs 4.1%, p=0.01) and metronidazole (42.9% vs 19.3%, p=0.04) were significantly associated with hospitalacquired C. difficile infection. Conclusions: Patients with type 2 diabetes mellitus admitted into acute medical wards and who developed hospital-acquired C. difficile infection have distinct characteristics.

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Section: Discussionmentioning

confidence: 99%

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hassan

Rahman²,

Huda³

et al. 2013

J R Coll Physicians Edinb

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“…In one retrospective study of 188 cases of CDI and 376 age-matched controls [22], 44 of the CDI cases had CKD, including 27 with stages 3-5 not on dialysis and 17 with ESRD requiring dialysis. In the control group, 68 cases had CKD: 54 with stages 3-5 CKD and 14 with ESRD on chronic dialysis.…”

Section: Discussionmentioning

confidence: 99%

Renal Impairment and Clinical Outcomes of <i>Clostridium difficile</i> Infection in Two Randomized Trials

et al. 2013

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Background/Aims: Patients with chronic kidney disease (CKD) have increased risk for Clostridium difficile infection (CDI) and for subsequent mortality. We determined the effect of CKD on response to treatment for CDI. Methods: This is a post hoc analysis of two randomized controlled phase 3 trials that enrolled patients with CDI. Patients received either fidaxomicin 200 mg b.i.d. or vancomycin 125 mg q.i.d. for 10 days. Univariate and multivariate analyses compared end points by treatment received and CKD stage. Results: At baseline, 27, 21, and 9% of the patients had stage 2 (60-89 ml/min/1.73 m²), stage 3 (30-59), and stage 4 or higher (<30) CKD. Cure rates were similar for normal (91%) and stage 2 CKD (92%), but declined to 80% for stage 3 and to 75% for stage 4 CKD (p < 0.001 for trend). Time to resolution of diarrhea (TTROD) increased with stage 3 and stage 4 CKD. CDI recurrence rates 4 weeks after treatment were 16, 20, 27, and 24% for normal, stage 2, stage 3, and stage 4 or higher CKD, respectively. Mortality increased with CKD stage. In multivariate analyses, stage 3 or higher CKD correlated with lower odds of cure, greater chance of recurrence, and lower odds of sustained response 28 days after treatment. Initial cure rates were similar in the vancomycin or fidaxomicin groups; however, the rate of recurrence was higher following vancomycin treatment independent of renal function. The presence of immunosuppression did not alter this effect. Conclusion: Progressive CKD is associated with increased TTROD, lower cure rates, and higher recurrence rates with treatment of CDI.

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“…In a multivariate analysis, CDAD was significantly associated with use of PPI (adjusted odds ratio [22] 4. In a case-control study increased incidence of CDAD was associated with female patients (adjusted OR 2.1, 95% CI 1.1-4.0), previous history of renal failure (adjusted OR 4.3, 95% CI 1.5-11.9) or hospital admission (adjusted OR 2.6, 95% CI 1.4-5.2) and with the use of PPI (adjusted OR 2.7, 95% CI 1.4-5.2) [23] 5. Other evidenced-based studies have been presented in Table 1.…”

Section: Difficile Associated Diarrheamentioning

confidence: 99%

Proton pump inhibitors and risk for Clostridium difficile associated diarrhea

Biswal¹

2014

Biomed J

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Chronic kidney disease as a risk factor for Clostridium difficile infection

Abstract: End-stage renal disease may increase the risk of acquiring CDAD through unknown mechanisms. This suggests implementing better surveillance strategies for these patients and eliminating the known risk factors for CDAD.

Cited by 58 publications

References 20 publications

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Renal Impairment and Clinical Outcomes of <i>Clostridium difficile</i> Infection in Two Randomized Trials

Proton pump inhibitors and risk for Clostridium difficile associated diarrhea

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