Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia.
File(s)
Published version
Author(s)
Chalmers, JD
Akram, AR
Singanayagam, A
Wilcox, MH
Hill, AT
Type
Journal Article
Abstract
OBJECTIVES: Clostridium difficile infection (CDI) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (CAP) is the leading indication for anti-biotic prescription in hospitals. This study assessed the incidence of and risk factors for CDI in a cohort of patients hospitalized with CAP. METHODS: We analysed data from a prospective, observational cohort of patients with CAP in Edinburgh, UK. Patients with diarrhoea were systematically screened for CDI, and risk factors were determined through time-dependent survival analysis. RESULTS: Overall, 1883 patients with CAP were included, 365 developed diarrhoea and 61 had laboratory-confirmed CDI. The risk factors for CDI were: age (hazard ratio [HR], 1.06 per year; 95% confidence interval [CI], 1.03-1.08), total number of antibiotic classes received (HR, 3.01 per class; 95% CI, 2.32-3.91), duration of antibiotic therapy (HR, 1.09 per day; 95% CI, 1.00-1.19 and hospitalization status (HR, 13.1; 95% CI, 6.0-28.7). Antibiotic class was not an independent predictor of CDI when adjusted for these risk factors (P > 0.05 by interaction testing). CONCLUSIONS: These data suggest that reducing the overall antibiotic burden, duration of antibiotic treatment and duration of hospital stay may reduce the incidence of CDI in patients with CAP.
Date Issued
2016-07-01
Date Acceptance
2016-04-11
Start Page
45
End Page
53
Journal / Book Title
J Infect
Volume
73
Issue
1
Copyright Statement
ª 2016 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/27105657
S0163-4453(16)30035-4
Subjects
Antibiotics
Clostridium difficile
Healthcare-associated infections
Macrolides
Pneumonia
Aged
Anti-Bacterial Agents
Clostridium Infections
Community-Acquired Infections
Diarrhea
Drug Utilization
Female
Hospitalization
Humans
Incidence
Male
Middle Aged
Prospective Studies
Risk Factors
United Kingdom
1103 Clinical Sciences
Microbiology
Publication Status
Published
Coverage Spatial
England