Maria C Mora Pinzon1, Ronald Buie2,3, Jinn-Ing Liou3,4, Daniel K Shirley4, Charlesnika T Evans5,6, Swetha Ramanathan5, Linda Poggensee5, Nasia Safdar3,4. 1. School of Medicine and Public Health, University of Wisconsin, Madison. 2. Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle. 3. William S. Middleton Memorial Veterans Affairs Hospital, Madison. 4. Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison. 5. Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines Jr Veterans Affairs Hospital, Chicago, Illinois. 6. Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, Illinois.
Abstract
BACKGROUND: Community-onset Clostridium difficile infections (CDI) are increasingly common, but there is little data on outcomes. The purpose of this study is to describe the epidemiology and outcomes of CDI in the Veterans Health Administration (VHA) system and compare these variables between hospital-onset (HCF) and community-onset (CO) cases. METHODS: We conducted a retrospective cohort study that included all patients with a positive test for C. difficile (toxin or toxin genes) within the VHA Corporate Data Warehouse between 2011 and 2014. RESULTS: We identified 19270 episodes of CDI, involving 15972 unique patients; 95% were male, 44% of the cases were HCF, and 42% were CO. Regarding severity, 31% percent of cases were non-severe, 40% were severe, and 21% were fulminant. Exposure to proton pump inhibitors was found in 53% of cases (47% in CO, 62% in HCF). Overall, 40% of patients received antibiotics in the 90 days before CDI (44% in HCF, 36% in CO). Recurrence was 18.2%, and 30-day all-cause mortality was 9.2%. Risk factors for a fulminant case were exposure to clindamycin (odds ratio [OR]: 1.23, P = .01) or proton pump inhibitors (OR: 1.20, P < .001) in the 90 days prior to diagnosis. CONCLUSIONS: CO accounts for a significant proportion of CDI in the VHA system. CO patients are younger and their cases are less severe, but recurrence is more common than in HCF CDI. Therefore CO CDI may account for a considerable reservoir of CDI cases, and prevention efforts should include interventions to reduce CO CDI.
BACKGROUND: Community-onset Clostridium difficile infections (CDI) are increasingly common, but there is little data on outcomes. The purpose of this study is to describe the epidemiology and outcomes of CDI in the Veterans Health Administration (VHA) system and compare these variables between hospital-onset (HCF) and community-onset (CO) cases. METHODS: We conducted a retrospective cohort study that included all patients with a positive test for C. difficile (toxin or toxin genes) within the VHA Corporate Data Warehouse between 2011 and 2014. RESULTS: We identified 19270 episodes of CDI, involving 15972 unique patients; 95% were male, 44% of the cases were HCF, and 42% were CO. Regarding severity, 31% percent of cases were non-severe, 40% were severe, and 21% were fulminant. Exposure to proton pump inhibitors was found in 53% of cases (47% in CO, 62% in HCF). Overall, 40% of patients received antibiotics in the 90 days before CDI (44% in HCF, 36% in CO). Recurrence was 18.2%, and 30-day all-cause mortality was 9.2%. Risk factors for a fulminant case were exposure to clindamycin (odds ratio [OR]: 1.23, P = .01) or proton pump inhibitors (OR: 1.20, P < .001) in the 90 days prior to diagnosis. CONCLUSIONS:CO accounts for a significant proportion of CDI in the VHA system. COpatients are younger and their cases are less severe, but recurrence is more common than in HCF CDI. Therefore CO CDI may account for a considerable reservoir of CDI cases, and prevention efforts should include interventions to reduce CO CDI.
Authors: Nieves Sopena; Jun Hao Wang-Wang; Irma Casas; Lourdes Mateu; Laia Castellà; María José García-Quesada; Sara Gutierrez; Josep M Llibre; M Luisa Pedro-Botet; Gema Fernandez-Rivas Journal: Microorganisms Date: 2022-05-23