Risk Factors Associated with C Diff Infection

Incidences of Clostridioides difficile infection have risen in recent years, and understanding risk factors can help practitioners address associated mortality, morbidity and health care costs.

Increased age, hospitalization, use of proton pump inhibitors and use of antibiotics were among the most prevalent risk factors for Clostridioides difficile infection (CDI), a recent study in Pakistan found.

The study, published in Cureus, included 200 patients diagnosed with C difficile-associated diarrhea (CDAD) at a tertiary care hospital in Pakistan between June 2020 and March 2021 along with 200 without CDAD in a control group.

“Identifying and addressing the risk factors associated with CDI will help in reducing the incidence of infection and associated complications,” the authors, led by Aarzoo Gupta of Vardhman Mahavir Medical College and Safdarjung Hospital in Faridabad, India, wrote.

The study included detailed histories of patients’ use of treatments (antibiotics, proton pump inhibitors and histamine 2 receptor antagonists), previous CDI diagnoses and hospitalization in the past 30 days. Investigators also noted patients’ body mass index (BMI) and comorbidities including diabetes, chronic kidney disease (CKD), hypertension, and malignancy.

In the case group, 31 patients were older than 65 (15.5%), compared with 16 (8%) in the control group (odds ratio 2.10 [1.11-3.99]; p, value, 0.02).

“This age group is not only termed as a risk factor for CDI, such patients also demonstrate poor prognosis, leading to increased clinical severity and death rates,” the authors wrote.

Patients with CDI also had significantly higher hospitalization (25.5% vs. 6%; OR, 5.36 [2.75-10.42]; p < 0.0001), use of proton pump inhibitors in last 30 days (23.0% vs. 10.5%; OR, 2.54 [1.45-4.45]; p, 0.001), and use of antibiotics in the last 30 days (36.0% vs. 10.5%; OR, 4.76 [2.80-8.19]; p < 0.0001).

“Studies have suggested that almost every antibiotic results in an increased chance of developing CDI,” the authors wrote. “This also includes the drugs that are used to treat CDI, namely metronidazole and vancomycin.”

Other risk factors included BMI above 25 kg/m2 (31% vs. 21%; OR, 1.69 [1.07-2.65]; p, 0.02), diabetes (27% vs.16%; OR 1.94 [1.18-2.17]; p, 0.008), CKD (19% vs. 9.5%; OR, 2.23 [1.23-4.03]; p, 0.007), and malignancy (6% vs. 2%; OR, 3.12 [0.99-9.86]; p, 0.05).

“Given the above-mentioned findings, our study suggests that the use of acid-suppressive agents should be carefully considered, and the over-the-counter availability of these agents should be discouraged,” the authors wrote. “This would help the doctors to keep a check in order to avoid overdose. Moreover, hygiene practices such as hand washing practices, sterilizing the used things at the hospital, using clean medical devices, etc. should be adopted to avoid the infection risk. Maximum management of antibiotic intake should also be taken into consideration.”

C diff is the leading cause of healthcare-associated infections, causing about a half million infections and $1 billion in healthcare costs each year.

While CDI is often associated with healthcare settings, a recent study by investigators at the University of Houston found that the bacterium is prevalent in a variety of settings, including on 45% of shoe soles.

Healthy people can carry C diff without illness or symptoms. Another recent study found that higher concentrations of C diff bacteria and toxins in stool samples was associated with more severe CDI.