Clinical and Microbiological Risk Factors for Community-Associated Clostridioides difficile Infections

Young Ah Kim1 , Heejung Kim2 , Dokyun Kim2 , Changseung Liu3 , Seok Hoon Jeong2

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

Corresponding author : hjkim12@yuhs.ac

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.

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.
*Others included AB11, AB15, AB21, AB23, AB27, AB30, AB32, AB33, AB37, AB38, AB39, AB43, AB45, AB47, AB59, AB62, AB72, AB84, AB85, AB86, AB89, C29, C3, C31, R020, R023, R027, R078, R081, R087, R088, R103, R137, R159, R161, R163, and R369.
Abbreviations: CDI, C. difficile infection; CA, community-associated; HA, healthcare-associated; PPI, proton pump inhibitor; ICU, intensive care unit; cdt, binary toxin; ST, sequence type.