Clinical and demographic profile and risk factors for Clostridium difficile infection
Abstract
Introduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease.
Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection.
Materials and methods: We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications.
Results: We collected data from 123 patients during the follow-up period, 30 of whom were positive for the toxin. Mean age in the study population was 49 years and 60% were men. The main symptoms were abdominal pain (35%) and fever (34%). The principal complications were electrolytic alteration and severe sepsis with secondary acute kidney injury. Mortality was 13% and independent factors associated to the appearance of the infection were the use of proton pump inhibitors and previous gastrointestinal tract surgery.
Conclusions: The use of proton pump inhibitors and previous gastrointestinal tract surgery were factors associated to C. difficile infection.
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References
Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978;298:531-4. http://dx.doi.org/10.1056/NEJM197803092981003
Bartlett JG. Antibiotic-associated diarrhea. N Engl J Med. 2002;346:334-9. http://dx.doi.org/10.1056/NEJMcp011603
Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442-9. http://dx.doi.org/10.1056/NEJMoa051639
Miller MA, Hyland M, Ofner-Agostini M, Gourdeau M, Ishak M. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol. 2002;23:137-40. http://dx.doi.org/10.1086/502023
O’Brien JA, Lahue BJ, Caro JJ, Davidson DM. The emerging infectious challenge of Clostridium difficile-associated disease in Massachusetts hospitals: Clinical and economic consequences. Infect Control Hosp Epidemiol. 2007;28:1219-27. http://dx.doi.org/10.1017/S0195941700026072
Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis. 2002;34:346-53. http://dx.doi.org/10.1086/338260
Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108:478-98. http://dx.doi.org/10.1038/ajg.2013.4
Olson MM, Shanholtzer CJ, Lee JT Jr. Gerding DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol. 1994;15:371-81.
Kwok CS, Arthur AK, Anibueze CI, Singh S, Cavallazzi R, Loke YK. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: Meta-analysis. Am J Gastroenterol. 2012;107:1011-9. http://dx.doi.org/10.1038/ajg.2012.108
McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med.1989;320:204-10. http://dx.doi.org/10.1056/
NEJM198901263200402
Al-Tureihi FI, Hassoun A, Wolf-Klein G, Isenberg H. Albumin, length of stay, and proton pump inhibitors: Key factors in Clostridium difficile-associated disease in nursing home patients. J Am Med Dir Assoc. 2005;6:105-8. http://dx.doi.org/10.1016/j.jamda.2005.01.003
Becerra MG, Ospina S, Atehortúa SL, Berbesi DY. Factores de riesgo para la infección por Clostridium difficile. Infectio. 2011;15:220-6.
Bliss DZ, Johnson S, Savik K, Clabots CR, Willard K, Gerding DN. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med. 1998;129:1012-9. http://dx.doi.org/10.7326/0003-4819-129-12-199812150-00004
Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31:431-55. http://dx.doi.org/10.1086/651706
Janarthanan S, Ditah I, Adler DG, Ehrinpreis MN. Clostridium difficile-associated diarrhea and proton pump inhibitor therapy: A meta-analysis. Am J Gastroenterol. 2012;107:1001-10. http://dx.doi.org/10.1038/ajg.2012.179
Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40:1591-7. http://dx.doi.org/10.1086/430315
Musher DM, Aslam S, Logan N, Nallacheru S, Bhaila I, Borchert F, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis. 2005;40:1586-90. http://dx.doi.org/10.1086/430311
Kulathinal S, Karvanen J, Saarela O, Kuulasmaa K. Casecohort design in practice - experiences from the MORGAM Project. Epidemiol Perspect Innov. 2007;4:15. http://dx.doi.org/10.1186/1742-5573-4-15
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619-36.
Álvarez-Lerma F, Palomar M, Villasboa A, Amador J, Almirall J, Posada MP, et al. Epidemiological study of Clostridium difficile infection in critical patients admitted to the Intensive Care Unit. Med Intensiva. 2014;38:558-66. http://dx.doi.org/10.1016/j.medin.2013.11.007
Camacho-Ortiz A, Ponce-de-León A, Sifuentes-Osornio J. Enfermedad asociada a Clostridium difficile en América Latina. Gac Méd Méx. 2009;145:223-9.
Kyne L, Merry C, O’Connell B, Kelly A, Keane C, O’Neill D. Factors associated with prolonged symptoms and severe disease due to Clostridium difficile. Age Ageing. 1999;28:107-13. http://dx.doi.org/10.1093/ageing/28.2.107
Turco R, Martinelli M, Miele E, Roscetto E, Del Pezzo M, Greco L, et al. Proton pump inhibitors as a risk factor for paediatric Clostridium difficile infection. Aliment Pharmacol Ther. 2010;31:754-9. http://dx.doi.org/10.1111/j.1365-2036.2009.04229.x
Karlstrom O, Fryklund B, Tullus K, Burman LG. A prospective nationwide study of Clostridium difficileassociated diarrhea in Sweden. The Swedish C. difficile Study Group. Clin Infect Dis. 1998;26:141-5. http://dx.doi.org/10.1086/516277
Kelly CP, Pothoulakis C, LaMont JT. Clostridium difficile colitis. N Engl J Med. 1994;330:257-62. http://dx.doi.org/10.1056/NEJM199401273300406
Micek ST, Schramm G, Morrow L, Frazee E, Personett H, Doherty JA, et al. Clostridium difficile infection: A multicenter study of epidemiology and outcomes in mechanically ventilated patients. Crit Care Med. 2013;41:1968-75. http://dx.doi.org/10.1097/CCM.0b013e31828a40d5.
Marcon AP, Gamba MA, Vianna LA. Nosocomial diarrhea in the intensive care unit. Braz J Infect Dis. 2006;10:384-9.
http://dx.doi.org/10.1590/S1413-86702006000600005 28. Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102:2047-56. http://dx.doi.org/10.1111/j.1572-0241.2007.01275.x
Zedtwitz-Liebenstein K, Wenisch C, Patruta S, Parschalk B, Daxbock F, Graninger W. Omeprazole treatment diminishes intra- and extracellular neutrophil reactive oxygen production and bactericidal activity. Crit Care Med. 2002;30:1118-22.
Agastya G, West BC, Callahan JM. Omeprazole inhibits phagocytosis and acidification of phagolysosomes of normal human neutrophils in vitro. Immunopharmacol Immunotoxicol. 2000;22:357-72. http://dx.doi.org/10.3109/08923970009016425
Hegarty JP, Sangster W, Harris LR 3rd, Stewart DB. Proton pump inhibitors induce changes in colonocyte gene expression that may affect Clostridium difficile infection. Surgery. 2014;156:972-8. http://dx.doi.org/10.1016/j.surg.2014.06.074
Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT. The burden of Clostridium difficile in surgical patients in the United States. Surg Infect (Larchmt). 2007;8:557-66. http://dx.doi.org/10.1089/sur.2006.062
Wijarnpreecha K, Sornprom S, Thongprayoon C, Phatharacharukul P, Cheungpasitporn W, Nakkala K. The risk of Clostridium difficile associated diarrhea in nasogastric tube insertion: A systematic review and metaanalysis. Dig Liver Dis.2016;48:468-72. http://dx.doi.org/10.1016/j.dld.2016.01.012
Iizuka M, Itou H, Konno S, Chihara J, Tobita M, Oyamada H, et al. Elemental diet modulates the growth of Clostridium difficile in the gut flora. Aliment Pharmacol Ther. 2004;20(Suppl.1):151-7.
May T, Mackie RI, Fahey GC Jr, Cremin JC, Garleb KA. Effect of fiber source on short-chain fatty acid production and on the growth and toxin production by Clostridium difficile. Scand J Gastroenterol. 1994;29:916-22.
Teasley DG, Gerding DN, Olson MM, Peterson LR, Gebhard RL, Schwartz MJ, et al. Prospective randomised trial of metronidazole versus vancomycin for Clostridium difficileassociated diarrhoea and colitis. Lancet. 1983;2:1043-6. http://dx.doi.org/10.1016/S0140-6736(83)91036-X
Silva J Jr, Batts DH, Fekety R, Plouffe JF, Rifkin GD, Baird I. Treatment of Clostridium difficile colitis and diarrhea with vancomycin. Am J Med. 1981;71:815-22.
Turgeon DK, Novicki TJ, Quick J, Carlson L, Miller P, Ulness B, et al. Six rapid tests for direct detection of Clostridium difficile and its toxins in fecal samples compared with the fibroblast cytotoxicity assay. J Clin Microbiol. 2003;41:667-70. http://dx.doi.org/10.1128/JCM.41.2.667-670.2003
Álvarez M, González R, Briceño I, Cofre C, Labarca J, Vial P, et al. Diagnosis of Clostridium difficile diarrhea: In search of a more efficient clinical focus. Rev Med Chil. 2001;129:620-5.
Fernández-Canigia L, Nazar J, Arce M, Dadamio J, Smayevsky J, Bianchini H. Clostridium difficile diarrhea: Frequency of detection in a medical center in Buenos Aires, Argentina. Rev Argent Microbiol. 2001;33:101-7.
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