Incidence and Risk Factors for Community and Hospital Acquisition of Clostridium difficile Infection in the Tel Aviv Sourasky Medical Center

Abstract

OBJECTIVES To estimate the incidence and identified risk factors for community-acquired (CA) and hospital-acquired (HA) Clostridium difficile infection (CDI) METHODS We conducted 2 parallel case-control studies at Tel Aviv Sourasky Medical Center from January 1, 2011, to December 31, 2014. We identified persons with CDI, determined whether infection was community or hospital acquired, and calculated incidence rates from 2007 to 2014. We collected demographic, clinical, and epidemiological information for CDI cases and hospitalized control cases and estimated the odds ratio with 95% confidence interval using conditional logistic regression. RESULTS In total, 1,563 CDI cases were identified in the study. The incidence rate of CA-CDI and HA-CDI increased by 1.6-fold and 1.2-fold, respectively, during 2012-2014. However, the incidence rate of CA-CDI was 0.84 per 100,000 (95% CI, 0.52-1.30), the rate for HA-CDI was 4.7 per 10,000 patient days (95% CI, 4.08-5.38), respectively, in 2014. We identified several factors as independent variables significantly associated with HA-CDI: functional disability, presence of nasogastric tube, antibiotic use, chemotherapy, infection by extended-spectrum β-lactamases, and mean of albumin values. Risk factors independently associated with CA-CDI were close contact with a family member who had been hospitalized in the previous 6 months, inflammatory bowel disease, and home density index (adjusted odds ratio, 25.7; 95% confidence interval, 3.99-165.54; P=.001). CONCLUSIONS The identification of the main modifiable risk factors for HA-CDI (antibiotic exposure and hypoalbuminemia) and for CA-CDI (close contact with a family member who had been hospitalized in the previous 6 months) is likely to optimize prevention efforts; these factors are critical in preventing the spread of CDI. Infect Control Hosp Epidemiol 2017;38:912-920.

Long-Term Antibiotic Prophylaxis in Urology and High Incidence of Clostridioides difficile Infections in Surgical Adult Patients

“…In addition, a study by Na'amnih et al linked IBD to an increased risk of developing CDI, which could be associated with altered host microbiota, as well as an increased permeability of the intestinal mucosa. However, interpretation of the results of this kind of research should be done cautiously [11].…”

Enhanced Humoral Immune Responses against Toxin A and B of Clostridium difficile is Associated with a Milder Disease Manifestation

“…The strong points of this study include the well-defined prospective case-control study of CDI risk factors [ 20 , 21 ], in which patients’ characteristics and samples were collected according to standardized protocols, the comprehensive assessment of both serum IgA and IgG levels against both C. difficile toxins, and the analytical approach that signifies the importance of all these markers in CDI severity. Our study has limitations—namely, the small sample size, especially the number of participants in the subgroups of disease severity, in addition to the lack of pre-existing sera.…”

“…The selection of hospital controls might be a limitation since they do not necessarily represent the general population. However, immunosuppression conditions that might negatively affect the immune system, such as cancer and chemotherapy, were more common among the CDI cases than the controls [ 20 , 21 ].…”

“…A case-control study on the risk factors of CDI was undertaken in 2011–2014 at Tel Aviv Sourasky Medical Center in Israel. Details on the study are published elsewhere [ 20 , 21 ]. Briefly, hospitalized cases with CDI and hospital controls not suffering from diarrhea were recruited.…”

“…In 2012, a 2-step algorithm was introduced. A combined glutamate dehydrogenase (GDH) and Toxin A/B immunochromatographic rapid assay (C. DIFF QUIK CHECK ® -Techlab, Orlando, FL, USA) was used at the initial step; if results were discordant, a polymerase chain reaction (PCR) (Xpert C. difficile , Cepheid, Sunnyvale, CA, USA) was utilized in the second step [ 20 , 21 ].…”