Risk factors for Clostridium difficile toxin-positive diarrhea: a population-based prospective case-control study

被引:44
作者
Vesteinsdottir, I. [2 ]
Gudlaugsdottir, S. [1 ]
Einarsdottir, R. [3 ]
Kalaitzakis, E. [4 ]
Sigurdardottir, O. [5 ]
Bjornsson, E. S. [1 ,2 ]
机构
[1] Natl Univ Hosp Iceland, Dept Gastroenterol & Hepatol, IS-101 Reykjavik, Iceland
[2] Univ Iceland, Fac Med, Reykjavik, Iceland
[3] Univ Iceland, Dept Pharm, Reykjavik, Iceland
[4] Skane Univ Hosp, Dept Gastroenterol, Lund, Sweden
[5] Akureyri Dist Hosp, Dept Clin Chem, Akureyri, Iceland
关键词
INFECTION; DISEASE; EMERGENCE;
D O I
10.1007/s10096-012-1603-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Increased incidence and severity of Clostridium difficile infections (CDIs) is of major concern. However, by minimizing known risk factors, the incidence can be decreased. The aim of this investigation was to calculate the incidence and assess risk factors for CDI in our population. A 1-year prospective population-based nationwide study in Iceland of CDIs was carried out. For risk factor evaluation, each case was matched with two age- and sex-matched controls that tested negative for C. difficile toxin. A total of 128 CDIs were identified. The crude incidence was 54 cases annually per 100,000 population > 18 years of age. Incidence increased exponentially with older age (319 per 100,000 population > 86 years of age). Community-acquired origin was 27 %. Independent risk factors included: dicloxacillin (odds ratio [OR]: 7.55, 95 % confidence interval [CI]: 1.89-30.1), clindamycin (OR: 6.09, 95 % CI: 2.23-16.61), ceftriaxone (OR: 4.28, 95 % CI: 1.59-11.49), living in a retirement home (OR: 3.9, 95 % CI: 1.69-9.16), recent hospital stay (OR: 2.3, 95 % CI: 1.37-3.87). Proton pump inhibitors (PPIs) were used by 60/111 (54 %) versus 91/222 (41 %) (p = 0.026) and ciprofloxacin 19/111 (17 %) versus 19/222 (9 %) (p = 0.027) for cases and controls, respectively. In all, 75 % of primary CDIs treated with metronidazole recovered from one course of treatment. CDI was mostly found among elderly patients. The most commonly identified risk factors were broad-spectrum antibiotics and recent contact with health care institutions. PPI use was significantly more prevalent among CDI patients.
引用
收藏
页码:2601 / 2610
页数:10
相关论文
共 28 条
[1]  
Al-Tureihi Farrah Ibrahim J, 2005, J Am Med Dir Assoc, V6, P105, DOI 10.1016/j.jamda.2005.01.003
[2]   Antibiotic-associated diarrhea [J].
Bartlett, JG .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (05) :334-339
[3]   Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands [J].
Bauer, M. P. ;
Veenendaal, D. ;
Verhoef, L. ;
Bloembergen, P. ;
van Dissel, J. T. ;
Kuijper, E. J. .
CLINICAL MICROBIOLOGY AND INFECTION, 2009, 15 (12) :1087-1092
[4]   Clostridium difficile infection in Europe: a hospital-based survey [J].
Bauer, Martijn P. ;
Notermans, Daan W. ;
van Benthem, Birgit H. B. ;
Brazier, Jon S. ;
Wilcox, Mark H. ;
Rupnik, Maja ;
Monnet, Dominique L. ;
van Dissel, Jaap T. ;
Kuijper, Ed J. .
LANCET, 2011, 377 (9759) :63-73
[5]   European Society of Clinical Microbiology and Infectious Diseases (ESCMID): Data review and recommendations for diagnosing Clostridium difficile-infection (CDI) [J].
Crobach, M. J. T. ;
Dekkers, O. M. ;
Wilcox, M. H. ;
Kuijper, E. J. .
CLINICAL MICROBIOLOGY AND INFECTION, 2009, 15 (12) :1053-1066
[6]   Clostridium difficile-associated disease in a setting of endemicity:: Identification of novel risk factors [J].
Dubberke, Erik R. ;
Reske, Kimberly A. ;
Yan, Yan ;
Olsen, Margaret A. ;
McDonald, L. Clifford ;
Fraser, Victoria J. .
CLINICAL INFECTIOUS DISEASES, 2007, 45 (12) :1543-1549
[7]  
Fellmeth Gracia, 2010, J Infect Public Health, V3, P118, DOI 10.1016/j.jiph.2010.07.002
[8]   Health Care-Associated Clostridium difficile Infection in Adults Admitted to Acute Care Hospitals in Canada: A Canadian Nosocomial Infection Surveillance Program Study [J].
Gravel, Denise ;
Miller, Mark ;
Simor, Andrew ;
Taylor, Geoffrey ;
Gardam, Michael ;
McGeer, Allison ;
Hutchinson, James ;
Moore, Dorothy ;
Kelly, Sharon ;
Boyd, David ;
Mulvey, Michael .
CLINICAL INFECTIOUS DISEASES, 2009, 48 (05) :568-576
[9]   Clostridium difficile infection in an endemic setting in the Netherlands [J].
Hensgens, M. P. M. ;
Goorhuis, A. ;
van Kinschot, C. M. J. ;
Crobach, M. J. T. ;
Harmanus, C. ;
Kuijper, E. J. .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2011, 30 (04) :587-593
[10]   Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics [J].
Hensgens, Marjolein P. M. ;
Goorhuis, Abraham ;
Dekkers, Olaf M. ;
Kuijper, Ed J. .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2012, 67 (03) :742-748