Is obesity a risk factor for Clostridium difficile infection?

Punni, Emma; Pula, Jaime L.; Asslo, Fady; Baddoura, Walid; DeBari, Vincent A.

doi:10.1016/j.orcp.2013.12.007

Cited by 19 publications

(9 citation statements)

References 21 publications

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“…Several reports have recently proposed obesity as a novel risk factor for CDI [104–106]. On the other hand, Punni et al [107], in a case-control study, showed that obesity is not a risk factor for CDI. Importantly, body mass > 35 index has been shown to be an independent risk factor for CDI [108].…”

Section: Risk Factorsmentioning

confidence: 99%

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

et al. 2019

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In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.

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Section: Risk Factorsmentioning

confidence: 99%

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

et al. 2019

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“…Commonly reported risk factors include advanced age, co–morbidities, use of antibiotics, proton pump inhibitors (PPIs), histamine–2 receptor antagonists (H2RA) and exposure to health care settings. Other risk factors have also implicated include obesity [18–20], non–steroidal anti–inflammatory drugs (NSAID) [21,22], vitamin D [23], and the role of host genetics in acquiring CDI [24]. We examined systematic reviews and meta–analyses on risk factors for CDI to provide an overview of the state of the evidence and discuss some of the challenges for epidemiological data synthesis for CDI and rCDI.…”

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confidence: 99%

Risk factors for Clostridium difficile infections – an overview of the evidence base and challenges in data synthesis

Eze

Balsells

Kyaw

2017

Journal of Global Health

151

110

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BackgroundRecognition of a broad spectrum of disease and development of Clostridium difficile infection (CDI) and recurrent CDI (rCDI) in populations previously considered to be at low risk has renewed attention on differences in the risk profile of patients. In the absence of primary prevention for CDI and limited treatment options, it is important to achieve a deep understanding of the multiple factors that influence the risk of developing CDI and rCDI.MethodsWe conducted a review of systematic reviews and meta–analyses on risk factors for CDI and rCDI published between 1990 and October 2016.Results22 systematic reviews assessing risk factors for CDI (n = 19) and rCDI (n = 6) were included. Meta–analyses were conducted in 17 of the systematic reviews. Over 40 risk factors have been associated with CDI and rCDI and can be classified into three categories: pharmacological risk factors, host–related risk factors, and clinical characteristics or interventions. Most systematic reviews and meta–analyses have focused on antibiotic use (n = 8 for CDI, 3 for rCDI), proton pump inhibitors (n = 8 for CDI, 4 for rCDI), and histamine 2 receptor antagonists (n = 4 for CDI) and chronic kidney disease (n = 4 for rCDI). However, other risk factors have been assessed. We discuss the state of the evidence, methods, and challenges for data synthesis.ConclusionSeveral studies, synthesized in different systematic review, provide valuable insights into the role of different risk factors for CDI. Meta–analytic evidence of association has been reported for factors such as antibiotics, gastric acid suppressants, non–selective NSAID, and some co–morbidities. However, despite statistical significance, issues of high heterogeneity, bias and confounding remain to be addressed effectively to improve overall risk estimates. Large, prospective primary studies on risk factors for CDI with standardised case definitions and stratified analyses are required to develop more accurate and robust estimates of risk effects that can inform targeted–CDI clinical management procedures, prevention, and research.

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“…A 10% rule was applied to identify any potential confounders from the list of covariates, including age, sex, ethnicity, preoperative BMI, diabetes status, and operation type; none of these covariates were shown to be confounders. Backward selection was performed with the variables age, sex, ethnicity, preoperative BMI (controlled for due to the conflicting findings with regard to the effect it has on C difficile infection risk), 12,[21][22][23][24] diabetes status, and surgical procedure type, as they were all significantly associated with C difficile infection and/or immunosuppressant use in bivariate analysis. To produce the final model (model 2), an adjusted logistic regression model controlling for the covariates from the backward selection process to determine the effect these covariates had on the potential relationship between C difficile infection and immunosuppressant use was run.…”

Section: Discussionmentioning

confidence: 99%

Immunosuppression and Clostridioides (Clostridium) difficile Infection Risk in Metabolic and Bariatric Surgery Patients

Marroquin

Xie

Uppuluri

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND: Immunosuppressant use increases risk of Clostridioides (Clostridium) difficile infection. To date, no studies have analyzed the relationship between immunosuppressant use and C difficile infections after metabolic and bariatric surgery (MBS). METHODS: A retrospective analysis of the 2015-2018 MBSAQIP data was conducted. The MBSAQIP data include information from 854 affiliated practices in the US and Canada. Initial sample size was 760,076 MBS patients. After excluding participants due to missing variables (n = 188,106) and the use of surgical procedures other than Roux-en-Y gastric bypass and sleeve gastroplasty (n = 129,712), final analyses were performed on 442,258 participants. Logistic regression models generated the odds of C difficile infection developing post MBS, according to immunosuppressant status (positive or negative). RESULTS: Unadjusted logistic regression analysis showed that patients using immunosuppressants were 95% more likely to have postoperative C difficile infection (odds ratio 1.945; 95% CI, 1.230 to 3.075; p < 0.001) vs MBS patients not taking immunosuppressants. After adjusting for age, sex, ethnicity, preoperative BMI, diabetes status, and surgical procedure type, the association remained unaffected (adjusted odds ratio 1.956; 95% CI, 1.236 to 3.095; p < 0.01). Patients who completed the laparoscopic Roux-en-Y gastric bypass procedure had more than double the odds of C difficile infection developing compared with those who completed the laparoscopic sleeve gastrectomy procedure (odds ratio 2.183; 95% CI, 1.842 to 2.587; p < 0.0001). CONCLUSIONS: Our results using a population-based sample of MBS patients showed that those taking immunosuppressants have a significantly higher risk of developing Clostridioides (Clostridium) difficile infection postoperatively. These findings suggest that patients using immunosuppressants should be closely monitored both pre and post procedure.

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Is obesity a risk factor for Clostridium difficile infection?

Cited by 19 publications

References 21 publications

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

Risk factors for Clostridium difficile infections – an overview of the evidence base and challenges in data synthesis

Immunosuppression and Clostridioides (Clostridium) difficile Infection Risk in Metabolic and Bariatric Surgery Patients

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