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Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study.

Publication ,  Journal Article
Kuntz, JL; Chrischilles, EA; Pendergast, JF; Herwaldt, LA; Polgreen, PM
Published in: BMC Infect Dis
July 15, 2011

BACKGROUND: Clostridium difficile is the most common cause of nosocomial infectious diarrhea in the United States. However, recent reports have documented that C. difficile infections (CDIs) are occurring among patients without traditional risk factors. The purpose of this study was to examine the epidemiology of CA-CDI, by estimating the incidence of CA-CDI and HA-CDI, identifying patient-related risk factors for CA-CDI, and describing adverse health outcomes of CA-CDI. METHODS: We conducted a population-based, retrospective, nested, case-control study within the University of Iowa Wellmark Data Repository from January 2004 to December 2007. We identified persons with CDI, determined whether infection was community-associated (CA) or hospital-acquired (HA), and calculated incidence rates. We collected demographic, clinical, and pharmacologic information for CA-CDI cases and controls (i.e., persons without CDI). We used conditional logistic regression to estimate the odds ratios (ORs) for potential risk factors for CA-CDI. RESULTS: The incidence rates for CA-CDI and HA-CDI were 11.16 and 12.1 cases per 100,000 person-years, respectively. CA-CDI cases were more likely than controls to receive antimicrobials (adjusted OR, 6.09 [95% CI 4.59-8.08]) and gastric acid suppressants (adjusted OR, 2.30 [95% CI 1.56-3.39]) in the 180 days before diagnosis. Controlling for other covariates, increased risk for CA-CDI was associated with use of beta-lactam/beta-lactamase inhibitors, cephalosporins, clindamycin, fluoroquinolones, macrolides, and penicillins. However, 27% of CA-CDI cases did not receive antimicrobials in the 180 days before their diagnoses, and 17% did not have any traditional risk factors for CDI. CONCLUSIONS: Our study documented that the epidemiology of CDI is changing, with CA-CDI occurring in populations not traditionally considered "high-risk" for the disease. Clinicians should consider this diagnosis and obtain appropriate diagnostic testing for outpatients with persistent or severe diarrhea who have even remote antimicrobial exposure.

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Published In

BMC Infect Dis

DOI

EISSN

1471-2334

Publication Date

July 15, 2011

Volume

11

Start / End Page

194

Location

England

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Odds Ratio
  • Middle Aged
  • Microbiology
  • Male
  • Logistic Models
  • Incidence
  • Humans
  • Female
 

Citation

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Kuntz, J. L., Chrischilles, E. A., Pendergast, J. F., Herwaldt, L. A., & Polgreen, P. M. (2011). Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study. BMC Infect Dis, 11, 194. https://doi.org/10.1186/1471-2334-11-194
Kuntz, Jennifer L., Elizabeth A. Chrischilles, Jane F. Pendergast, Loreen A. Herwaldt, and Philip M. Polgreen. “Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study.BMC Infect Dis 11 (July 15, 2011): 194. https://doi.org/10.1186/1471-2334-11-194.
Kuntz JL, Chrischilles EA, Pendergast JF, Herwaldt LA, Polgreen PM. Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study. BMC Infect Dis. 2011 Jul 15;11:194.
Kuntz, Jennifer L., et al. “Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study.BMC Infect Dis, vol. 11, July 2011, p. 194. Pubmed, doi:10.1186/1471-2334-11-194.
Kuntz JL, Chrischilles EA, Pendergast JF, Herwaldt LA, Polgreen PM. Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study. BMC Infect Dis. 2011 Jul 15;11:194.
Journal cover image

Published In

BMC Infect Dis

DOI

EISSN

1471-2334

Publication Date

July 15, 2011

Volume

11

Start / End Page

194

Location

England

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Odds Ratio
  • Middle Aged
  • Microbiology
  • Male
  • Logistic Models
  • Incidence
  • Humans
  • Female