Jiang Q, Liu DX, Lu W, Sang HF, Gong XM, Li YL. Identification of risk factors for Clostridium difficile infection in older adult hospitalized patients with pressure ulcers. World J Gastroenterol 2025; 31(36): 110355 [DOI: 10.3748/wjg.v31.i36.110355]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Qin Jiang, Dong-Xin Liu, Wei Lu, Department of Laboratory Medicine, Hangzhou Geriatric Hospital, Hangzhou 310022, Zhejiang Province, China
Hong-Fei Sang, Department of Neurology, Hangzhou Geriatric Hospital, Hangzhou 310022, Zhejiang Province, China
Xiao-Mei Gong, Department of Hospital Infection Control, Hangzhou Geriatric Hospital, Hangzhou 310022, Zhejiang Province, China
Yu-Lei Li, Department of Rehabilitation Medicine, Hangzhou Geriatric Hospital, Hangzhou 310022, Zhejiang Province, China
Author contributions: Jiang Q, Liu DX, and Lu W were responsible for the experimental operation; Sang HF, Gong XM, and Li YL were responsible for the feasibility assessment of the research method, data analysis and interpretation, and core discussion and revision of the conclusion; Jiang Q and Li YL were responsible for the writing and revision of the paper. All the authors participated in the discussion of the results and made revisions to the manuscript.
Supported by the Zhejiang Province Medical and Health Science and Technology Plan Project, No. 2018KY644 and No. 2020KY234.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Hangzhou First People's Hospital (Approval No. 2019182-01).
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request at 502240541@qq.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: June 11, 2025 Revised: July 31, 2025 Accepted: August 21, 2025 Published online: September 28, 2025 Processing time: 100 Days and 21.8 Hours
Abstract
BACKGROUND
Clostridium difficile (C. difficile) infection (CDI) is a common healthcare-associated infection. Older adult hospitalized patients with pressure ulcers are more susceptible because of low immunity and disordered flora, but their specific risk factors are unknown. This study hypothesizes that the use of antibiotics for more than 2 weeks, the use of proton pump inhibitors (PPIs), and the use of β-lactam antibiotics are independent risk factors for CDI in this population.
AIM
To determine the risk factors for CDI in hospitalized older adults with pressure ulcers.
METHODS
A total of 120 older adults hospitalized with pressure ulcers from 2020 to 2023 were enrolled in the wound repair ward of the hospital. Stool samples were collected for anaerobic culture, C. difficile glutamate dehydrogenase (GDH) antigen and toxin detection, and multivariate logistic regression was used to analyze risk factors.
RESULTS
Among 120 older adults hospitalized patients with pressure ulcers, 39 tested positive for C. difficile, with an incidence rate of 32.5%. Thirty-nine patients (32.5%) were positive for GDH antigen. Twelve patients (10.0%) were positive for toxin A/B. Multivariate analysis shows that the use of antibiotics for more than 2 weeks, the use of proton pump inhibitors, and the use of β-lactam antibiotics are independent risk factors for CDI (all P values < 0.05).
CONCLUSION
From 2020 to 2023, the incidence of CDI in 120 hospitalized older adult patients with pressure ulcers was 32.5%, and three independent risk factors were identified.
Core Tip: This study shows that the incidence of Clostridium difficile infection inolder adult hospitalized patients with pressure ulcers is 32.5%. The use of antibiotics for more than 2 weeks, the use of proton pump inhibitors, and the use of β-lactam antibiotics are independent risk factors, providing important evidence for targeted clinical prevention and control.
