Who is at risk for clostridium difficile

The effect of antibiotics can last as long as several months. If you come in contact with C. You may be wondering… What is sepsis? Yes, but most healthy adults who come in contact with C. Sometimes when healthy people come into contact with C.

Colonization is more common than C. Once your body is colonized, you can remain colonized for several months. If you are colonized with C. Once your body is colonized with C. This is because many people colonized with C. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. If you're well enough to recover from Clostridium difficile C. Your GP may contact you regularly to make sure you're getting better.

Call them if your symptoms return after treatment finishes, as it may need to be repeated. The bacteria often live harmlessly because other bacteria normally found in the bowel keep it under control. But some antibiotics can interfere with the balance of bacteria in the bowel, which can cause the C. When this happens, C. Once out of the body, the bacteria turn into resistant cells called spores. These can survive for long periods on hands, surfaces such as toilets , objects and clothing unless they're thoroughly cleaned, and can infect someone else if they get into their mouth.

Someone with a C. You can reduce your risk of picking it up or spreading it by practising good hygiene, both at home and in healthcare settings. Find out how to prevent germs spreading. Page last reviewed: 23 November Next review due: 23 November These outbreaks decreased in the UK after the strict restriction of the use of fluoroquinolones 9.

Prior hospitalization has been demonstrated as a risk factor for CDI even after adjusting for increasing age 13 , with longer duration of stay associated with higher risk In contrast some studies examining CDI risk factors have revealed conflicting information 15 — For example, the role of proton pump inhibitors PPIs as a risk factor for CDI is controversial, possibly due to ascertainment bias relating to choice of control patients Risk prediction models have had variable success; models developed in single center derivation cohorts have not proved robust in validation cohorts 20 , 21 , possibly due to the selection of the derivation cohort.

Furthermore, interpretation of some CDI risk factors studies can be complicated by the following: 1 inclusion of cases with recurrent infection, rather than only those with primary disease, 2 use of non-robust case definitions, and 3 use of different diagnostic methodologies 16 , 22 — Our study aimed to determine the risk factors for developing primary CDI in hospitalized patients and compare the risks across distinct patient groups.

We used two groups of CDI cases and controls, defined according to standardized laboratory testing, 22 — 24 across multiple hospitals and countries in Europe. The first group of cases and controls were based on a point prevalence study of CDI [EUropean, multi-center, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhea EUCLID ] and included 59 hospitals in seven countries across Europe that were identified as having higher rates of infection Czech Republic, Germany, Hungary, Poland, Portugal, Romania, and Slovakia From these predefined patient groups, we conducted a retrospective case-control study to determine the risk factors for CDI in hospitalized patients.

For inclusion in the study, a case was defined as a patient with a positive result for both glutamate dehydrogenase GDH and C. For each confirmed CDI case, four geographically matched controls i. Risk factor data were extracted from available medical records via a standardized clinical report form CRF , and were sent to the study coordinator for upload into the central database.

The index sample was the sample that defined entry into the study [either positive cases or negative controls ]. For the analysis population, participants were removed from control groups if they had evidence of previous CDI within the preceding 8 weeks or within the subsequent 8 weeks of the index sample. Cases were classified as primary CDI where there was no positive toxin text in the 8 weeks prior to the index sample; otherwise cases were classified as recurrence.

In addition, for the multivariate analysis all cases that had a previous toxin positive fecal sample were removed, so ensuring that only primary and not recurrent CDI cases were included for risk factor analyses; matched controls were not removed for this analysis. Distribution of demographics, concomitant pathogens, medical conditions, medical procedures, and medications were tabulated by cases and controls.

Where data were continuous variables, means, and standard deviations were calculated; where these data had a highly skewed distribution, medians, 25th and 75th percentiles were also calculated. Where data were categorical variables, the number, and percentage of participants within each category were calculated. The percentage of missing values was reported for each variable. Univariate analysis was first used to assess risk factors; continuous variables were compared between cases and controls by t -test; where skewed, variables were also compared by Mann—Whitney test; categorical variables were compared by chi-squared Fishers exact where numbers were below 5.

Unadjusted odds ratios were calculated for association of CDI with identified variables of interest. Ethical approval in Germany was sought on a regional state basis, in response to different regional requirements. There were slightly more males than females, both overall ratio 1. Table 1. Age and gender for all participants, per group, and per cases and controls. Cases were significantly older than controls in both groups. Table 2. Categorical variable with a statistically significant difference between cases and controls within at least one of the participant cohorts risk factors consistently significant in both cohorts are shown in bold.

The reason for admission and the medical specialty ward where the subject was located at the time index sample was taken were examined. The length of time between the index sample and a subsequent sample being taken for testing was 21 days longer in cases than controls median 37 vs.

In addition, cases were also significantly more likely to have a positive test result for C. Only 3. For the PSS group, cases were significantly more likely to be tested for CDI both before and after the index sample than controls, possibly indicative of repeated episodes of diarrhea.

Interestingly, however, samples from PSS cases were only more likely to be positive after an index sample. The majority of cases from both cohorts likely represent primary infection Table 3. Metric variables with a statistically significant difference between cases and controls within at least one participant cohort. Cases in both groups were associated with higher Charlson comorbidity scores, with Antibiotics were more likely to have been prescribed for an infection acute use in cases of CDI, whereas in controls these were significantly associated with prophylactic use Table 2.

Broad-spectrum antibiotics commonly associated with CDI were significantly more likely to have been prescribed to cases than to controls Table 2. The median duration of antibiotic treatment days was longer in cases than in controls in the PSS group only 6 vs.

Antibiotics given by the oral route were significantly more likely to be prescribed to cases than controls in the EUCLID group There was significantly more PPI use in the cases than the controls Chemotherapy was significantly more frequently seen in controls vs. Cases were significantly more likely to have had surgery in the preceding 12 weeks in both groups PSS In the PSS group, elective surgery was significantly more common in cases than controls In addition, these cases were also more likely to have had vascular surgery than controls In both groups antibiotics received by cases as treatment for infection acute use was associated with a significantly increased risk of CDI ORs 2.

Overall, the odds of developing CDI increased by 1. As would be expected with a disease where most cases are related to contact with a healthcare facility, prior hospital admission has been widely described as a risk factor for CDI 25 , Increased age and concomitant antibiotics are also frequently reported risk factors 15 , 16 , For some authors, the impact of antibiotics on the gut microbiome makes them perhaps the most important risk factor Indeed our study demonstrates that the risk of CDI increased by 1.

Importantly, our results demonstrate these particular risk factors remained significant across different patient populations; vital information for those designing vaccine studies.