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Incidence and Risk Factors for Community and Hospital Acquisition of Clostridium difficile Infection in the Tel Aviv Sourasky Medical Center

Published online by Cambridge University Press:  31 May 2017

Wasef Na’amnih*
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Israel; Gertner Institute, Sheba Medical Center, Tel Hashomer 52621, Israel ([email protected])
Amos Adler
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
Tamar Miller-Roll
Affiliation:
Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
Dani Cohen
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
Yehuda Carmeli
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
*
Address correspondence to W. Na’amnih, MSc, Israel Center for Disease Control Gertner Institute, Sheba Medical Center, Tel Hashomer 52621, Israel ([email protected]).

Abstract

OBJECTIVES

To estimate the incidence and identified risk factors for community-acquired (CA) and hospital-acquired (HA) Clostridium difficile infection (CDI)

METHODS

We conducted 2 parallel case-control studies at Tel Aviv Sourasky Medical Center from January 1, 2011, to December 31, 2014. We identified persons with CDI, determined whether infection was community or hospital acquired, and calculated incidence rates from 2007 to 2014. We collected demographic, clinical, and epidemiological information for CDI cases and hospitalized control cases and estimated the odds ratio with 95% confidence interval using conditional logistic regression.

RESULTS

In total, 1,563 CDI cases were identified in the study. The incidence rate of CA-CDI and HA-CDI increased by 1.6-fold and 1.2-fold, respectively, during 2012–2014. However, the incidence rate of CA-CDI was 0.84 per 100,000 (95% CI, 0.52–1.30), the rate for HA-CDI was 4.7 per 10,000 patient days (95% CI, 4.08–5.38), respectively, in 2014. We identified several factors as independent variables significantly associated with HA-CDI: functional disability, presence of nasogastric tube, antibiotic use, chemotherapy, infection by extended-spectrum β-lactamases, and mean of albumin values. Risk factors independently associated with CA-CDI were close contact with a family member who had been hospitalized in the previous 6 months, inflammatory bowel disease, and home density index (adjusted odds ratio, 25.7; 95% confidence interval, 3.99–165.54; P=.001).

CONCLUSIONS

The identification of the main modifiable risk factors for HA-CDI (antibiotic exposure and hypoalbuminemia) and for CA-CDI (close contact with a family member who had been hospitalized in the previous 6 months) is likely to optimize prevention efforts; these factors are critical in preventing the spread of CDI.

Infect Control Hosp Epidemiol 2017;38:912–920

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Kelly, CP, LaMont, JT. Clostridium difficile—more difficult than ever. New Engl J Med 2008;359:19321940.CrossRefGoogle ScholarPubMed
2. Bauer, MP, Veenendaal, D, Verhoef, L, Bloembergen, P, Van Dissel, JT, Kuijper, EJ. Clinical and microbiological characteristics of community-onset Clostridium difficile infection in the Netherlands. Clin Microbiol Infect 2009;15:10871092.CrossRefGoogle ScholarPubMed
3. Fellmetha, G, Yarlagaddaa, S, Iyer, S. Epidemiology of community-onset Clostridium difficile infection in a community in the South of England. J Infect Public Health 2010;3:118123.CrossRefGoogle Scholar
4. Bauer, MP, Goorhuis, A, Koster, T, et al. Community-onset Clostridium difficile-associated diarrhea not associated with antibiotic usage—two case reports with review of the changing epidemiology of Clostridium difficile-associated diarrhea. Neth J Med 2008;66:207211.Google ScholarPubMed
5. Naggie, S, Frederick, J, Pien, BC, et al. Community-associated Clostridium difficile infection: experience of a veteran affairs medical center in the southeastern USA. Infection 2010;38:297300.Google Scholar
6. Naggie, S, Miller, BA, Zuzak, KB, et al. A case-control study of community-associated Clostridium difficile infection: no role for proton pump inhibitors. Am J Med 2011;124:276.e1276.e7.Google Scholar
7. Kutty, PK, Woods, CW, Sena, AC, et al. Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA. Emerg Infect Dis 2010;16:197204.CrossRefGoogle ScholarPubMed
8. Burke, KE, Lamont, JT. Clostridium difficile infection: a worldwide disease. Gut Liver 2014;8:16.Google Scholar
9. Freeman, J, Bauer, MP, Baines, SD, et al. The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 2010;23:529549.Google Scholar
10. Gilca, R, Hubert, B, Fortin, E, Gaulin, C, Dionne, M. Epidemiological patterns and hospital characteristics associated with increased incidence of Clostridium difficile infection in Quebec, Canada, 1998–2006. Infect Control Hosp Epidemiol 2010;31:939947.Google Scholar
11. Kuijper, EJ, Coignard, B, Tull, P. Emergence of Clostridium difficile associated disease in North America and Europe. Clin Microbiology Infect 2006;12:218.Google Scholar
12. Kuntz, JL, Chrischilles, EA, Pendergast, J, Herwaldt, LA, Polgreen, MP. Incidence of and risk factors for community associated Clostridium difficile infection: a nested case-control study. BMC Infect Dis 2011;11:194201.Google Scholar
13. Khanna, S, Pardi, DS, Aronson, SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:8995.CrossRefGoogle ScholarPubMed
14. Lucado, J, Gould, C, Elixhauser, A. Clostridium difficile infections (CDI) in hospital stays, 2009. Statistical brief #124. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality website. http://www.hcupus.ahrq.gov/reports/statbriefs/sb124.pdf. Published 2009. Accessed January 8, 2012.Google Scholar
15. McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006;12:409415.CrossRefGoogle ScholarPubMed
16. Svenungsson, B, Burman, LG, Jalakas-Pornull, K, Lagergren, A, Struwe, J, Akerlund, T. Epidemiology and molecular characterization of Clostridium difficile strains from patients with diarrhea: low disease incidence and evidence of limited cross-infection in a Swedish teaching hospital. J Clin Microbiol 2003;41:40314037.CrossRefGoogle Scholar
17. Wilcox, MH, Mooney, L, Bendall, R, Settle, CD, Fawley, WN. A case-control study of community-associated Clostridium difficile infection. J Antimicrob Chemother 2008;62:388396.Google Scholar
18. Larentis, DZ, Rosa, RG, Dos-Santos, RP, Goldani, LZ. Outcomes and risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients. Gastroenterol Res Pract 2015;ID:346341.Google Scholar
19. King, RN, Lager, SL. Incidence of Clostridium difficile infections in patients receiving antimicrobial and acid-suppression therapy. Pharmacotherapy 2011;31:642648.Google Scholar
20. Obritsch, MD, Stroup, JS, Carnahan, RM, Scheck, DN. Clostridium difficile-associated diarrhea in a tertiary care medical center. Proc (Bayl Univ Med Cent) 2010;23:363367.Google Scholar
21. McFarland, LV, Clarridge, JE, Beneda, HW, Raugi, GJ. Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a Veterans Administration health care system. Clin Infect Dis 2007;45:11411151.Google Scholar
22. Faleck, DM, Salmasian, H, Furuya, EY, Larson, EL, Abrams, JA, Freedberg, DE. Proton pump inhibitors do not affect risk for Clostridium difficile infection in the intensive care unit. Am J Gastroenterol 2016;111:16411648.Google Scholar
23. Prasad, N, Labaze, G, Kopacz, J, et al. Asymptomatic rectal colonization with carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care facility in New York City. Am J Infect Control 2016;44:525532.Google Scholar
24. Patricia, AF, Wu Lai, TI, Garcia-Salmones, M, Saavedra-Cervera, B, Garcia-Salguero, C, Merino, P. Clostridium difficile, are all our patients diagnosed? Epub 2015;30:7985.Google Scholar
25. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for –infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431455.CrossRefGoogle Scholar
26. Lihua, Z, Danfeng, D, Cen, J, Xuefeng, W, Yibing, P. Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital. J Infect Dev Countries 2015;9:381387.Google Scholar
27. Center for Disease Control. Surveillance for community-associated Clostridium difficile–Connecticut, 2006. MMWR 2008;57:340343.Google Scholar
28. Gupta, A, Khanna, S. Community-acquired Clostridium difficile infection: an increasing public health threat. Infect Drug Resist 2014;7:6372.Google Scholar
29. Tracey, L, Kirke, A, Armstrong, P, Riley, TV. From the hospital to the home—the rise and rise of Clostridium difficile infection. Aust Fam Physician 2015;44:712717.Google Scholar
30. Freedberg, DE, Abrams, JA. Clostridium difficile infection in the community: are proton pump inhibitors to blame? World J Gastroenterol 2013;19:67106713.Google Scholar
31. Dial, S, Delaney, JA, Barkun, AN, Suissa, S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005;294:29892995.Google Scholar
32. Pepin, J, Saheb, N, Coulombe, MA, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:12541260.Google Scholar
33. Khanna, S, Aronson, SL, Kammer, PP, Baddour, LM, Pardi, DS. Gastric acid suppression and outcomes in Clostridium difficile infection: a population-based study. Mayo Clin Proc 2012;87:636642.Google Scholar
34. Issa, M, Vijayapal, A, Graham, MB, et al. Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol 2007;5:345351.Google Scholar
35. Rodemann, JF, Dubberke, ER, Reske, KA, Seo da, H, Stone, CD. Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol 2007;5:339344.Google Scholar
36. Berg, AM, Kelly, CP, Farraye, FA. Clostridium difficile infection in the inflammatory bowel disease patient. Inflamm Bowel Dis 2013;19:194204.Google Scholar
37. Wang, Y, Atreja, A, Wu, X, Lashner, BA, Brzezinski, A, Shen, B. Similar outcomes of IBD in patients with Clostridium difficile infection detected by ELISA or PCR assay. Dig Dis Sci 2013;58:23082313.Google Scholar
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