Risk Factors for and Estimated Incidence of Community-associated<i>Clostridium difficile</i>Infection, North Carolina, USA<sup>1</sup>

Kutty, Preeta K.; Woods, Christopher W.; Seña, Arlene C.; Benoit, Stephen R.; Naggie, Susanna; Frederick, Joyce; Evans, Sharon F.; Engel, Jeffery; McDonald, L. Clifford

doi:10.3201/eid1602.090953

Cited by 198 publications

(134 citation statements)

References 28 publications

(34 reference statements)

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…Two publications reported results divided into groups. Kutty et al 30 presented the results of 2 populations (Veterans Affairs and Durham County residents), whereas Soes et al 28,29 presented the results divided into 2 age groups (<2 years and ≥2 years). Among the included studies, 7 were case-control studies and 5 were nested case-control studies.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Furuya‐Kanamori

Stone

Clark³

et al. 2014

Infect. Control Hosp. Epidemiol.

142

103

View full text Add to dashboard Cite

background. Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. methods. A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.

show abstract

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Furuya‐Kanamori

Stone

Clark³

et al. 2014

Infect. Control Hosp. Epidemiol.

142

103

View full text Add to dashboard Cite

show abstract

“…Recurrence 100 (11) 23 (13) 20 (11) 33 (13) 24 (7) .04 Severe disease b 76 (8) 9 (5) 10 (5) 21 (9) 36 (11) .08 Stool collected as outpatient 830 (88) 161 (94) 167 (89) 218 (89) 284 (84) .005 Hospitalized within 7 days of outpatient stool collection 154 (19) 18 (11) 30 (18) 36 (17) 70 (25) .004 Admitted to ICU 6 (4) 0 1 4 (11) 1 (1) .07 Underlying medical conditions, any c 395 (42) 49 (29) 73 (39) 96 (39) 177 (52) ,.001 Pulmonary disease 64 (16) 7 (14) 12 (16) 15 (16) 30 (17) .11 Hematologic or solid malignancy 52 (13) 5 (10) 9 (12) 14 (15) 24 (14) .97 Inflammatory bowel disease 28 (7) 0 1 (1) 7 (7) 20 (11 (31) 21 (38) 33 (49) 20 (22) 24 (24) .0008 Folic acid inhibitors 53 (17) 6 (11) 14 (21) 15 (16) 18 (18) .52 Clindamycin 27 (9) 0 1 (1) 7 (8) 19 (19) ,.0001 Macrolide 27 (9) 6 (11) 6 …”

Section: Figurementioning

confidence: 99%

“…16 Women have been reported to have a higher incidence of CDI than men in studies involving adult populations, but no difference in incidence was seen between girls and boys in our study. 17 Environmental exposures that confer risk for C difficile acquisition may differ by gender among adults but not among children. CDI incidence is higher among white than nonwhite populations in our data, which may be explained by higher outpatient health care utilization reported among whites than nonwhites, likely reflecting, in part, differences in health care access.…”

Section: Figurementioning

confidence: 99%

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

et al. 2014

Self Cite

View full text Add to dashboard Cite

OBJECTIVE: Little is known about the epidemiology of Clostridium difficile infection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups. METHODS: Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010–2011 were used to identify cases (ie, residents with C difficile–positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years. RESULTS: Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100 000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks. CONCLUSIONS: Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.

show abstract

“…In at least one large study, the incidence of community-acquired CDI (CA-CDI) in patients with no traditional risk factor was equal to the CDI incidence in at-risk populations (167). This observation is backed up by reports from others (168,169), as well as by data from the U.S. Centers for Disease Control and Prevention (170), and suggests that the incidence of CA-CDI is on the rise.…”

Section: History and Emergence Of Nap1/027/bi Strainsmentioning

confidence: 62%

Variations in Virulence and Molecular Biology among Emerging Strains of Clostridium difficile

Hunt

Ballard

2013

Microbiol Mol Biol Rev

View full text Add to dashboard Cite

SUMMARY Clostridium difficile is a Gram-positive, spore-forming organism which infects and colonizes the large intestine, produces potent toxins, triggers inflammation, and causes significant systemic complications. Treating C. difficile infection (CDI) has always been difficult, because the disease is both caused and resolved by antibiotic treatment. For three and a half decades, C. difficile has presented a treatment challenge to clinicians, and the situation took a turn for the worse about 10 years ago. An increase in epidemic outbreaks related to CDI was first noticed around 2003, and these outbreaks correlated with a sudden increase in the mortality rate of this illness. Further studies discovered that these changes in CDI epidemiology were associated with the rapid emergence of hypervirulent strains of C. difficile , now collectively referred to as NAP1/BI/027 strains. The discovery of new epidemic strains of C. difficile has provided a unique opportunity for retrospective and prospective studies that have sought to understand how these strains have essentially replaced more historical strains as a major cause of CDI. Moreover, detailed studies on the pathogenesis of NAP1/BI/027 strains are leading to new hypotheses on how this emerging strain causes severe disease and is more commonly associated with epidemics. In this review, we provide an overview of CDI, discuss critical mechanisms of C. difficile virulence, and explain how differences in virulence-associated factors between historical and newly emerging strains might explain the hypervirulence exhibited by this pathogen during the past decade.

show abstract

Risk Factors for and Estimated Incidence of Community-associatedClostridium difficileInfection, North Carolina, USA¹

Abstract: Antimicrobial drug exposure is the most common modifiable risk factor for infection.

Cited by 198 publications

References 28 publications

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

Variations in Virulence and Molecular Biology among Emerging Strains of Clostridium difficile

Contact Info

Product

Resources

About

Risk Factors for and Estimated Incidence of Community-associatedClostridium difficileInfection, North Carolina, USA1

Abstract: Antimicrobial drug exposure is the most common modifiable risk factor for infection.

Cited by 198 publications

References 28 publications

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

Variations in Virulence and Molecular Biology among Emerging Strains of Clostridium difficile

Contact Info

Product

Resources

About

Risk Factors for and Estimated Incidence of Community-associatedClostridium difficileInfection, North Carolina, USA¹