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

Vesteinsdottir, I.; Gudlaugsdottir, S.; Einarsdottir, R.; Kalaitzakis, Evangelos LU ; Sigurdardottir, O. and Bjornsson, E. S. (2012) In European Journal of Clinical Microbiology & Infectious Diseases 31(10). p.2601-2610
Abstract
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).... (More)
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. (Less)
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type
Contribution to journal
publication status
published
subject
in
European Journal of Clinical Microbiology & Infectious Diseases
volume
31
issue
10
pages
2601 - 2610
publisher
Springer
external identifiers
  • wos:000309214300014
  • scopus:84869122095
ISSN
1435-4373
DOI
10.1007/s10096-012-1603-0
language
English
LU publication?
yes
id
23a9b117-69ff-42c2-bd09-fba8b6a90515 (old id 3189841)
date added to LUP
2012-12-03 07:09:58
date last changed
2017-10-08 03:47:45
@article{23a9b117-69ff-42c2-bd09-fba8b6a90515,
  abstract     = {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.},
  author       = {Vesteinsdottir, I. and Gudlaugsdottir, S. and Einarsdottir, R. and Kalaitzakis, Evangelos and Sigurdardottir, O. and Bjornsson, E. S.},
  issn         = {1435-4373},
  language     = {eng},
  number       = {10},
  pages        = {2601--2610},
  publisher    = {Springer},
  series       = {European Journal of Clinical Microbiology & Infectious Diseases},
  title        = {Risk factors for Clostridium difficile toxin-positive diarrhea: a population-based prospective case-control study},
  url          = {http://dx.doi.org/10.1007/s10096-012-1603-0},
  volume       = {31},
  year         = {2012},
}