Clinical and Microbiological Risk Factors for Community-Associated Clostridioides difficile Infections
1Department of Laboratory Medicine, National Health Insurance Service, Ilsan Hospital, Goyang
2Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul
3Department of Laboratory Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
ABSTRACT
Background: The incidence of community-associated (CA) Clostridioides difficile infection (CDI) has increased in Korea. In this study, we evaluated CA-CDI risk factors in terms of clinical features and ribotype considering its region-specific molecular epidemiology.
Methods: A retrospective case-control study was performed on two groups of CDI patients: 127 subjects with CA-CDI and 265 subjects with healthcare-associated (HA)-CDI. Risk factors for CA-CDI were evaluated in terms of clinical and microbiological features such as toxin type and ribotype.
Results: A comparison of the two groups of CDI patients revealed that inflammatory bowel disease, diarrhea, abdominal pain, and fever were more closely associated with CA-CDI. The toxin types and ribotypes of C. difficile were similar between the two groups. After adjusting for variables, no risk factors were identified for CA-CDI compared with HA-CDI.
Conclusion: Specific risk factors for CA-CDI were not identified in this study.
Keywords
Clostridioides difficile infection, Community-associated, Risk factor
Figures & Tables
Table 1. Comparison between CA-CDI and HA-CDI groups
|
Variables |
CA-CDI (n = 127) |
HA-CDI (n = 265) |
P-value |
|
Age (yr) |
66.9±18.9 |
72.1±13.5 |
0.0064 |
|
Sex, male |
51 (40.2) |
120 (45.3) |
0.3386 |
|
Charlson comorbidity index |
2.4±2.1 |
2.7±1.9 |
0.1109 |
|
Associated disease |
|||
|
Biliary tract disease |
3 (2.4) |
8 (3.0) |
0.7133 |
|
Cancer |
22 (17.3) |
59 (22.3) |
0.2593 |
|
Pneumonia |
18 (14.2) |
57 (21.5) |
0.0863 |
|
Heart failure |
5 (3.9) |
8 (3.0) |
0.6357 |
|
Chronic respiratory disease |
5 (3.9) |
22 (8.3) |
0.1185 |
|
Chronic renal disease |
24 (18.9) |
42 (15.9) |
0.4508 |
|
Diabetes mellitus |
23 (18.1) |
38 (14.3) |
0.3361 |
|
Cerebrovascular disease |
7 (5.5) |
34 (12.8) |
0.0314 |
|
Alcohol disorder |
5 (3.9) |
4 (1.5) |
0.1481 |
|
Osteoarthritis |
0 |
4 (1.5) |
0.9836 |
|
Atherosclerosis |
4 (3.2) |
9 (3.4) |
0.8985 |
|
Esophageal disorder |
1 (0.8) |
8 (3.0) |
0.2000 |
|
Nutrition deficiency |
1 (0.8) |
4 (1.5) |
0.5580 |
|
Inflammatory bowel disease |
8 (6.3) |
1 (0.4) |
0.0070 |
|
Gastric ulcer |
2 (1.6) |
10 (3.8) |
0.2518 |
|
History of antimicrobial use |
|||
|
Any |
104 (81.9) |
244 (92.1) |
0.0036 |
|
Penicillin |
28 (22.1) |
73 (27.6) |
0.2448 |
|
Narrow-spectrum cephalosporin |
12 (9.5) |
37 (14.0) |
0.2090 |
|
Extended-spectrum cephalosporin |
31 (24.4) |
69 (26.0) |
0.7293 |
|
Inhibitor-combination |
12 (9.5) |
60 (22.6) |
0.0022 |
|
Carbapenem |
9 (7.1) |
46 (17.4) |
0.0080 |
|
Fluoroquinolone |
16 (12.6) |
58 (21.9) |
0.0298 |
|
Teicoplanin |
4 (3.2) |
39 (14.7) |
0.0019 |
|
Aminoglycoside |
0 |
5 (1.9) |
0.9880 |
|
History of PPI use |
13 (10.2) |
34 (12.8) |
0.4603 |
|
History of chemotherapy |
13 (10.2) |
28 (10.6) |
0.9209 |
|
CDI-associated symptom |
|||
|
Diarrhea |
84 (66.1) |
122 (46.0) |
0.0002 |
|
Abdominal pain |
29 (22.8) |
29 (10.9) |
0.0023 |
|
Fever (> 38°C) |
26 (20.5) |
33 (12.5) |
0.0394 |
|
Prognosis |
|||
|
Recovery |
112 (88.9) |
224 (84.5) |
0.2486 |
|
Recurrence |
4 (3.2) |
15 (5.7) |
0.2855 |
|
ICU admission |
3 (2.4) |
19 (7.2) |
0.0677 |
|
Crude mortality |
14 (11.0) |
44 (16.6) |
0.1559 |
|
C. difficile toxin |
|||
|
A+B+cdt – |
115 (90.6) |
232 (87.6) |
0.3826 |
|
B only |
8 (6.3) |
22 (8.3) |
0.4852 |
|
A+B+cdt+ |
4 (3.2) |
11 (4.2) |
0.6286 |
|
Ribotypes of C. difficile |
|||
|
AB24 (ST129) |
3 (2.4) |
8 (3.0) |
0.7133 |
|
AB25 (ST102) |
5 (3.9) |
8 (3.0) |
0.6357 |
|
Ribotype 001 |
6 (4.7) |
16 (6.0) |
0.5979 |
|
Ribotype 002 |
12 (9.5) |
17 (6.4) |
0.2856 |
|
Ribotype 012 |
8 (6.3) |
14 (5.3) |
0.6828 |
|
Ribotype 014/020 |
17 (13.4) |
43 (16.2) |
0.4654 |
|
Ribotype 017 |
5 (3.4) |
18 (6.8) |
0.2660 |
|
Ribotype 018 |
29 (22.8) |
58 (21.9) |
0.8318 |
|
Ribotype 046 |
4 (3.2) |
18 (6.8) |
0.1523 |
|
Ribotype 070 |
3 (2.4) |
4 (1.5) |
0.5540 |
|
Ribotype 106 |
8 (6.3) |
14 (5.3) |
0.6828 |
|
Others* |
27(21.3) |
47(17.7) |
0.4046 |
|
Data are presented in number (%) or mean±standard deviation; Bold format indicates statistical significance. |
|||