Factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI) in a Mexican tertiary care hospital: A case-control study

Abstract

ObjectiveTo identify clinical and environmental factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI).DesignCase-control study.SettingPublic, acute care, academic tertiary referral center in Mexico.PatientsAdults hospitalized ≥48 hours between January 2015 and December 2016 were included. Cases were patients with a first episode of HO-HCFA CDI. Controls were patients with any other diagnosis; they were randomly selected from the hospital discharge database and matched in a 1:2 manner according to the date of diagnosis of case ± 10 days. Variables with p<0.1 were considered for multivariable analysis.ResultsOne hundred and fifty-five cases and 310 controls were included. Variables independently associated with HO-HCFA CDI were: exposure to both ciprofloxacin and proton pump inhibitor (PPI) within the last 3 months (OR = 8.07, 95% CI = 1.70–38.16), febrile neutropenia (OR = 4.61, 95% CI = 1.37–15.46), intraabdominal infection (OR = 2.06, 95% CI = 0.95–4.46), referral from other hospitals (OR = 1.99, 95% CI = 0.98–4.05) and an increasing number of antibiotics previously used (OR = 1.28, 95% CI = 1.13–1.46).ConclusionsMultiple factors were found to be associated with the first episode of HO-HCFA CDI in the setting of an outbreak; of the modifiable risk factors, prior exposure to both ciprofloxacin and PPI was the most important. Referral from other hospitals was an environmental risk factor that deserves further study.

Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries

“… 31 Additionally, in a case-control study conducted at a tertiary hospital in Mexico, previous antibiotic use was more frequent (95.9% vs 79.9%; p < 0.001) and the number of antibiotics used was higher (3 vs 2; p < 0.001) in cases versus controls, respectively. 32 Similarly, another case-control study conducted at a tertiary care hospital in Mexico found that prior antibiotic exposure was the most significant risk factor associated with CDI. 33 A systematic review of studies in Brazil from 1988 to 2018 also concluded that the major risk factors for CDI were the number of previous antibiotics and duration of therapy.…”

“… 28 Similarly, hospital-based studies from Brazil and Mexico found a significant association with development of CDI and carbapenem use. 32 , 36 Conversely, a study of eight university hospitals in Brazil found exposure to fluoroquinolones to be the only variable associated with development of CDI, whereas carbapenem exposure was not significantly associated. 37 …”

Substantial reduction of healthcare facility-onset Clostridioides difficile infection (HO-CDI) rates after conversion of a hospital for exclusive treatment of COVID-19 patients

“…The most frequent comorbidities in Mexican COVID-19 patients are hypertension, obesity and diabetes, unlike patients admitted to this hospital before conversion. 8 Following conversion, no external patients with preexisting CDI were hospitalized, reducing environmental contamination. These features seemed to overcome the deleterious effect of the high rate of antibiotic use in patients after conversion.…”

Undercooked Leghorn Chicken is A Source of Campylobacter Jejuni, An Infectious Agent for Causing Prosthetic Joint Infection and Diarrhea

“…However, long-term antibacterial therapy causes a risk of tendinopathy in patients [24][25][26]. Another risk also includes Clostridiodes difficile infection, which is more commonly observed when concurrent proton-pump inhibitor therapy is given to the patient [27,28]. Our patient had been taking Ciprofloxacin.…”