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Risk factors for Clostridioides difficile colonization among hospitalized adults: A meta-analysis and systematic review

Published online by Cambridge University Press:  29 October 2020

Scott Anjewierden Open the ORCID record for Scott Anjewierden [Opens in a new window] ,
Zheyi Han ,
Adam M. Brown ,
Curtis J. Donskey  and
Abhishek Deshpande Open the ORCID record for Abhishek Deshpande [Opens in a new window]
Scott Anjewierden
Affiliation:
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
Zheyi Han
Affiliation:
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
Adam M. Brown
Affiliation:
University of Cincinnati College of Medicine, Cincinnati, Ohio
Curtis J. Donskey
Affiliation:
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans’ Affairs Medical Center, Cleveland, Ohio
Abhishek Deshpande*
Affiliation:
Medicine Institute, Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
*
Author for correspondence: Abhishek Deshpande, E-mail: [email protected]
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Abstract

Objective:

To identify risk factors for asymptomatic Clostridioides difficile colonization among hospitalized adults utilizing a meta-analysis, which may enable early identification of colonized patients at risk of spreading C. difficile.

Design:

Meta-analysis and systematic review.

Methods:

We systematically searched MEDLINE, Scopus, Web of Science, and EMBASE from January 1, 1975, to February 15, 2020, for articles related to C. difficile colonization among hospitalized adults. Studies with multivariable analyses evaluating risk factors for asymptomatic colonization were eligible.

Results:

Among 5,506 studies identified in the search, 19 studies met the inclusion criteria. Included studies reported 20,334 adult patients of whom 1,588 were asymptomatically colonized with C. difficile. Factors associated with an increased risk of colonization were hospitalization in the previous 6 months (OR, 2.18; 95% CI, 1.86–2.56; P < .001), use of gastric acid suppression therapy within the previous 8 weeks (OR, 1.42; 95% CI, 1.17–1.73; P < .001), tube feeding (OR, 2.02; 95% CI, 1.06–3.85; P = .03), and corticosteroid use in the previous 8 weeks (OR, 1.58; 95% CI, 1.14–2.17; P = .006). Receipt of antibiotics in the previous 3 months (OR, 1.37; 95% CI, 0.94–2.01; P = .10) was not associated with statistically significant effects on risk of colonization.

Conclusions:

C. difficile colonization was significantly associated with previous hospitalization, gastric acid suppression, tube feeding, and corticosteroid use. Recognition of these risk factors may assist in identifying asymptomatic carriers of C. difficile and taking appropriate measures to reduce transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 5 , May 2021 , pp. 565 - 572
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

a

Authors of equal contribution.

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