Stefano Di Bella1, Alexander W Friedrich2, Esther García-Almodóvar3, Maria Serena Gallone4, Fabrizio Taglietti5, Simone Topino6, Vincenzo Galati7, Emma Johnson8, Silvia D'Arezzo9, Nicola Petrosillo10. 1. National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. stefano932@gmail.com. 2. Department of Medical Microbiology and Infection Control, University Medical Centre, Groeningen, The Netherlands. alex.friedrich@umcg.nl. 3. Department of Internal Medicine, Manacor Hospital, Palma of Majorca, Spain. egalmodovar@gmail.com. 4. Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy. serenagallone@gmail.com. 5. National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. fabrizio.taglietti@inmi.it. 6. National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. simone.topino@inmi.it. 7. National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. vincenzo.galati@inmi.it. 8. University of Sheffield, Sheffield, UK. e.johnson@sheffield.ac.uk. 9. National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. silvia.darezzo@inmi.it. 10. National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. nicola.petrosillo@inmi.it.
Abstract
BACKGROUND: HIV infection is a risk factor for Clostridium difficile infection (CDI) yet the immune deficiency predisposing to CDI is not well understood, despite an increasing incidence of CDI among such individuals. We aimed to estimate the incidence and to evaluate the risk factors of CDI among an HIV cohort in Italy. METHODS: We conducted a retrospective case-control (1:2) study. Clinical records of HIV inpatients admitted to the National Institute for Infectious Disease "L. Spallanzani", Rome, were reviewed (2002-2013). CASES: HIV inpatients with HO-HCFA CDI, and controls: HIV inpatients without CDI, were matched by gender and age. Logistic regression was used to identify risk factors associated with CDI. RESULTS: We found 79 CDI episodes (5.1 per 1000 HIV hospital admissions, 3.4 per 10000 HIV patient-days). The mean age of cases was 46 years. At univariate analysis factors associated with CDI included: antimycobacterial drug exposure, treatment for Pneumocystis pneumonia, acid suppressant exposure, previous hospitalization, antibiotic exposure, low CD4 cell count, high Charlson score, low creatinine, low albumin and low gammaglobulin level. Using multivariate analysis, lower gammaglobulin level and low serum albumin at admission were independently associated with CDI among HIV-infected patients. CONCLUSIONS: Low gammaglobulin and low albumin levels at admission are associated with an increased risk of developing CDI. A deficiency in humoral immunity appears to play a major role in the development of CDI. The potential protective role of albumin warrants further investigation.
BACKGROUND:HIV infection is a risk factor for Clostridium difficile infection (CDI) yet the immune deficiency predisposing to CDI is not well understood, despite an increasing incidence of CDI among such individuals. We aimed to estimate the incidence and to evaluate the risk factors of CDI among an HIV cohort in Italy. METHODS: We conducted a retrospective case-control (1:2) study. Clinical records of HIV inpatients admitted to the National Institute for Infectious Disease "L. Spallanzani", Rome, were reviewed (2002-2013). CASES: HIV inpatients with HO-HCFA CDI, and controls: HIV inpatients without CDI, were matched by gender and age. Logistic regression was used to identify risk factors associated with CDI. RESULTS: We found 79 CDI episodes (5.1 per 1000 HIV hospital admissions, 3.4 per 10000 HIV patient-days). The mean age of cases was 46 years. At univariate analysis factors associated with CDI included: antimycobacterial drug exposure, treatment for Pneumocystis pneumonia, acid suppressant exposure, previous hospitalization, antibiotic exposure, low CD4 cell count, high Charlson score, low creatinine, low albumin and low gammaglobulin level. Using multivariate analysis, lower gammaglobulin level and low serum albumin at admission were independently associated with CDI among HIV-infectedpatients. CONCLUSIONS: Low gammaglobulin and low albumin levels at admission are associated with an increased risk of developing CDI. A deficiency in humoral immunity appears to play a major role in the development of CDI. The potential protective role of albumin warrants further investigation.
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