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Bjöersdorff OG, Lindberg S, Kiil K, Persson S, Guardabassi L, Damborg P. Dogs are carriers of Clostridioides difficile lineages associated with human community-acquired infections. Anaerobe 2021; 67:102317. [PMID: 33418077 DOI: 10.1016/j.anaerobe.2020.102317] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/26/2020] [Indexed: 12/19/2022]
Abstract
There is an increasing concern about the role of animals as reservoirs of Clostridioides difficile. In this study, we investigated prevalence, antimicrobial resistance and zoonotic potential of C. difficile in dogs. Two-hundred and twenty-five dog faecal deposits were collected from trashcans in nine public gardens. C. difficile was isolated using selective plating and enrichment culture, identified by MALDI-TOF, tested for susceptibility to seven antibiotics by E-test, and sequenced on an Illumina NextSeq platform. Genome sequences were analysed to determine multilocus sequence types and resistance and toxin gene profiles. Zoonotic potential was assessed by measuring genetic variations of core genome (cg)MLST types between canine isolates and 216 temporally and spatially related human clinical isolates from a national database. C. difficile was isolated from 11 samples (4.9%). Seven isolates were toxigenic (tcdA+, tcdB+, cdtA/B-) and belonged to the sequence types ST2, ST6, ST10 and ST42. The four non-toxigenic isolates were assigned to ST15, ST26 and one novel ST. ST2, corresponding to PCR ribotype RT014/020, was the dominating lineage (n = 4) and, together with ST26 and ST42 isolates, showed close resemblance to human isolates, i.e. 2-5 allelic differences among the 1999 genes analysed by cgMLST. Three non-toxigenic isolates displayed resistance to clindamycin, erythromycin and tetracycline mediated by erm(B) and tet(M). Resistance to metronidazole, moxifloxacine, rifampicin or vancomycin was not detected. In conclusion, a small proportion of faecal deposits contained toxigenic C. difficile such as ST2 (RT014/020), which is a major cause of community-acquired infections. Our finding suggests that pathogenic strains can be exchanged between dogs and humans.
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Affiliation(s)
- Olivia Graaf Bjöersdorff
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Sanna Lindberg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Kristoffer Kiil
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Søren Persson
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Luca Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Peter Damborg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark.
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Clostridium difficile Infection in Children: Epidemiology and Trend in a Swedish Tertiary Care Hospital. Pediatr Infect Dis J 2019; 38:1208-1213. [PMID: 31738336 DOI: 10.1097/inf.0000000000002480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Several studies have shown an increasing trend in pediatric Clostridium difficile infection (CDI). However, the Public Health Agency in Sweden reports a decreasing incidence of CDI in the Swedish population since 2007. The main aim of this study is to analyze the epidemiology of CDI in children. METHODS Retrospective chart-review of patients 1 to <19 years old, positive for Clostridium difficile toxin B, tested at Karolinska University Hospital Units, over the time period from July 1, 2010 to June 30, 2018. Episodes were classified as recurrences (≥2 weeks, ≤8 weeks from previous episode) or new episodes (>8 weeks from previous episode). New episodes were classified as hospital- (HA-CDI) or community-associated (CA-CDI). Annual infection rates/100,000 children in the catchment area were calculated. RESULTS Three hundred twenty-eight positive tests in 206 patients were included of which 259 (79.0%) tests were new episodes and 69 (21.0%) recurrences. In 63/206 (30.6%) children, >1 episode of CDI was recorded. The mean infection rate was 8.5/100,000 children. There was an overall increasing trend in CDI-rate July 2010-June 2018, however not statistically significant (P = 0.061) nor for the incidence in HA-CDI (P = 0.720) or CA-CDI (P = 0.179). Underlying medical conditions were present in 226/259 (87.3%) new episodes of which the most common was malignancy. Of the new episodes, 188/259 (72.6%) were HA-CDI and 46/259 (17.8%) were CA-CDI. CONCLUSIONS There was an increasing trend in CDI in children in Sweden from 2010 to 2018, although not statistically significant. CDI was associated with comorbid conditions and repeated episodes were common.
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3
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Balsells E, Shi T, Leese C, Lyell I, Burrows J, Wiuff C, Campbell H, Kyaw MH, Nair H. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Glob Health 2019; 9:010407. [PMID: 30603078 PMCID: PMC6304170 DOI: 10.7189/jogh.09.010407] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Clostridium difficile is a leading cause of morbidity and mortality in several countries. However, there are limited evidence characterizing its role as a global public health problem. We conducted a systematic review to provide a comprehensive overview of C. difficile infections (CDI) rates. Methods Seven databases were searched (January 2016) to identify studies and surveillance reports published between 2005 and 2015 reporting CDI incidence rates. CDI incidence rates for health care facility-associated (HCF), hospital onset-health care facility-associated, medical or general intensive care unit (ICU), internal medicine (IM), long-term care facility (LTCF), and community-associated (CA) were extracted and standardized. Meta-analysis was conducted using a random effects model. Results 229 publications, with data from 41 countries, were included. The overall rate of HCF-CDI was 2.24 (95% confidence interval CI = 1.66-3.03) per 1000 admissions/y and 3.54 (95%CI = 3.19-3.92) per 10 000 patient-days/y. Estimated rates for CDI with onset in ICU or IM wards were 11.08 (95%CI = 7.19-17.08) and 10.80 (95%CI = 3.15-37.06) per 1000 admission/y, respectively. Rates for CA-CDI were lower: 0.55 (95%CI = 0.13-2.37) per 1000 admissions/y. CDI rates were generally higher in North America and among the elderly but similar rates were identified in other regions and age groups. Conclusions Our review highlights the widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community.
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Affiliation(s)
- Evelyn Balsells
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Joint first authorship
| | - Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Joint first authorship
| | - Callum Leese
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Iona Lyell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Burrows
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Joint last authorship
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Joint last authorship
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4
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Barbut F, Day N, Bouée S, Youssouf A, Grandvoinnet L, Lalande V, Couturier J, Eckert C. Toxigenic Clostridium difficile carriage in general practice: results of a laboratory-based cohort study. Clin Microbiol Infect 2019; 25:588-594. [PMID: 30616013 DOI: 10.1016/j.cmi.2018.12.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Reported rates of community-acquired Clostridium difficile infections (CDIs) have been increasing. However, the true burden of the disease in general practice is unknown in France. Our objective was to determine the incidence of toxigenic C. difficile carriage and the percentage of stool samples prescribed by general practitioners (GPs) which contained free C. difficile toxins. METHODS During an 11-month period, all stool samples submitted for any enteric pathogen detection to 15 different private laboratories in Paris and the surrounding areas were tested for C. difficile, irrespective of the GPs' request. A clinical questionnaire was completed for each patient. Stool samples were screened using a rapid simultaneous glutamate dehydrogenase and toxins A/B detection test: any positive result (glutamate dehydrogenase or toxin) was further confirmed by the stool cytotoxicity assay (CTA) on MRC-5 cells and by toxigenic culture (TC) at a central laboratory. The C. difficile isolates were characterized by PCR ribotyping. RESULTS A total of 2541 patients (1295 female, 1246 male) were included. The incidences of patients with a positive toxigenic culture and a positive CTA were 3.27% (95% CI 2.61%-4.03%) and 1.81% (95% CI 1.33%-2.41%), respectively. GPs requested C. difficile testing in only 12.93% of the stool samples, detecting 52.30% of all TC-positive patients. The 83 toxigenic C. difficile strains belonged to 36 different PCR ribotypes. CONCLUSIONS Toxigenic C. difficile carriage is frequent in general practice but remains under-recognized. It may affect young patients without previous antimicrobial therapy or hospitalization.
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Affiliation(s)
- F Barbut
- National Reference Laboratory for Clostridium difficile, Paris, France; Department of Bacteriology, AP-HP, Saint-Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Paris, France; INSERM 1139, Université Paris Descartes, Paris, France.
| | - N Day
- Laboratory of Chemin Vert, Paris, France
| | - S Bouée
- CEMKA-EVAL, Bourg la Reine, France
| | - A Youssouf
- National Reference Laboratory for Clostridium difficile, Paris, France; Department of Bacteriology, AP-HP, Saint-Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | | | - V Lalande
- Department of Bacteriology, AP-HP, Saint-Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - J Couturier
- National Reference Laboratory for Clostridium difficile, Paris, France; Department of Bacteriology, AP-HP, Saint-Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Paris, France
| | - C Eckert
- National Reference Laboratory for Clostridium difficile, Paris, France; Department of Bacteriology, AP-HP, Saint-Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Paris, France; Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI), Paris, France.
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Cryptosporidium Species are Frequently Present But Rarely Detected in Clinical Samples From Children with Diarrhea in a Developed Country. Pediatr Infect Dis J 2018; 37:e138-e140. [PMID: 28938260 DOI: 10.1097/inf.0000000000001794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two studies were done on cryptosporidiosis in children. A retrospective survey showed that from 2005 to 2015, Cryptosporidium species was detected by microscopy of stool from 0.25% of children with diarrhea. In a subsequent prospective study, polymerase chain reaction detected Cryptosporidium species in 4 (1.3%) of 304 children. Cryptosporidium species is as frequent as other intestinal pathogens in childhood diarrhea. Testing is relevant.
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Kotila SM, Mentula S, Ollgren J, Virolainen-Julkunen A, Lyytikäinen O. Community- and Healthcare-Associated Clostridium difficile Infections, Finland, 2008-2013. Emerg Infect Dis 2018; 22:1747-1753. [PMID: 27648884 PMCID: PMC5038409 DOI: 10.3201/eid2210.151492] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Prudent use of antimicrobial drugs in outpatient settings is needed for reducing the burden of infection. We evaluated incidence, case-fatality rate, and trends of community-associated (CA) and healthcare-associated (HA) Clostridium difficile infections (CDIs) in Finland during 2008–2013. CDIs were identified in the National Infectious Disease Register, deaths in the National Population Information System, hospitalizations to classify infections as CA or HA in the National Hospital Discharge Register, and genotypes in a reference laboratory. A total of 32,991 CDIs were identified: 10,643 (32.3%) were CA (32.9 cases/100,000 population) and 22,348 (67.7%) HA (69.1/100,000). Overall annual incidence decreased from 118.7/100,000 in 2008 to 92.1/100,000 in 2013, which was caused by reduction in HA-CDI rates (average annual decrease 8.1%; p<0.001). The 30-day case-fatality rate was lower for CA-CDIs than for HA-CDIs (3.2% vs. 13.3%; p<0.001). PCR ribotypes 027 and 001 were more common in HA-CDIs than in CA-CDIs. Although the HA-CDI incidence rate decreased, which was probably caused by increased awareness and improved infection control, the CA-CDI rate increased.
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7
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Kwon SS, Gim JL, Kim MS, Kim H, Choi JY, Yong D, Lee K. Clinical and molecular characteristics of community-acquired Clostridium difficile infections in comparison with those of hospital-acquired C. difficile. Anaerobe 2017; 48:42-46. [PMID: 28655581 DOI: 10.1016/j.anaerobe.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 11/29/2022]
Abstract
Community-acquired Clostridium difficile infection (CA-CDI) is a growing concern. CA-CDI differs from hospital-acquired C. difficile infection (HA-CDI) in its epidemiology, risk factors, severity, and outcomes. In this study, we investigated C. difficile infections in a tertiary care hospital in Seoul, Korea, and compared the CA-CDI and HA-CDI cases diagnosed in the same period. Total 593 cases were confirmed as CDI in 2014, of which CA-CDI accounted for 68 (11.5%) of the total CDI cases. Compared with HA-CDI, the mean age of CA-CDI cases was lower than that of HA-CDI (42.7 vs 60.4). In CA-CDI, antibiotic and proton pump inhibitor (PPI) use in the 12 preceding weeks and concurrent chemotherapy and tube feeding were less frequent compared with HA-CDI. In most cases (63/68, 92.6%), patients with CA-CDI recovered without any complications or recurrence. The most prevalent C. difficile type in CA-CDI cases was PCR-ribotype 012, accounting for 18.3% of the total, followed by PCR-ribotype 018 (16.7%).
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Affiliation(s)
- Soon Sung Kwon
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Lim Gim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung Sook Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Heejung Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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8
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Bauer MP, Kuijper J. Clostridium difficile Infections in Hospitals and Community. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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McFarland LV, Ozen M, Dinleyici EC, Goh S. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol 2016; 22:3078-3104. [PMID: 27003987 PMCID: PMC4789985 DOI: 10.3748/wjg.v22.i11.3078] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/12/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
Antibiotic-associated diarrhea (AAD) and Clostridum difficile infections (CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases PubMed (June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications (required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar (discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.
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Olesen B, Hallberg H, Bangsborg J, Jensen JN, Jarløv JO. A new approach to recognition of Clostridium difficile infections with community onset. Clin Microbiol Infect 2015; 21:e55-6. [PMID: 25895635 DOI: 10.1016/j.cmi.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/09/2015] [Indexed: 01/05/2023]
Affiliation(s)
- B Olesen
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark.
| | - H Hallberg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - J Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - J N Jensen
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - J O Jarløv
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
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Gerding DN, Lessa FC. The epidemiology of Clostridium difficile infection inside and outside health care institutions. Infect Dis Clin North Am 2015; 29:37-50. [PMID: 25582647 PMCID: PMC10924674 DOI: 10.1016/j.idc.2014.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article describes the global changes in Clostridium difficile epidemiology since the late twentieth century and into the twenty-first century when the new epidemic strain BI/NAP1/027 emerged. The article provides an overview of how understanding of C difficile epidemiology has rapidly evolved since its initial association with colitis in 1974. It also discusses how C difficile has spread across the globe, the role of asymptomatic carriers in disease transmission, the increased recognition of C difficile outside health care settings, the changes in epidemiology of C difficile infection in children, and the risk factors for disease.
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Affiliation(s)
- Dale N Gerding
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Avenue, Maywood, IL 60153, USA; Research Service, Edward Hines, Jr. Veterans Affairs Hospital, 5000 South Fifth Avenue, Building 1, Room 347, Hines, IL 60141, USA.
| | - Fernanda C Lessa
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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12
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Furuya-Kanamori L, Stone JC, Clark J, McKenzie SJ, Yakob L, Paterson DL, Riley TV, Doi SAR, Clements AC. Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2015; 36:132-41. [PMID: 25632995 DOI: 10.1017/ice.2014.39] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. METHODS A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted. RESULTS Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80-10.04) and corticosteroid (1.81; 1.15-2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52-9.12), renal failure (2.64; 1.23-5.68), hematologic cancer (1.75; 1.02-5.68), and diabetes mellitus (1.15; 1.05-1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years. CONCLUSIONS Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
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Affiliation(s)
- Luis Furuya-Kanamori
- 1Research School of Population Health,Australian National University,Canberra,Australia
| | - Jennifer C Stone
- 2School of Population Health,University of Queensland,Herston,Australia
| | | | | | - Laith Yakob
- 4Department of Disease Control,London School of Hygiene & Tropical Medicine,London,UK
| | - David L Paterson
- 5University of Queensland,UQ Centre for Clinical Research,Herston,Australia
| | - Thomas V Riley
- 6Microbiology & Immunology,University of Western Australia, andDepartment of Microbiology PathWest Laboratory Medicine,Queen Elizabeth II Medical Centre,Nedlands,Australia
| | - Suhail A R Doi
- 2School of Population Health,University of Queensland,Herston,Australia
| | - Archie C Clements
- 1Research School of Population Health,Australian National University,Canberra,Australia
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Affiliation(s)
- J.J. Keller
- Medisch Centrum Haaglanden, The Hague, The Netherlands;
| | - E.J. Kuijper
- Department of Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
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