Outcomes of Community and Healthcare-onsetClostridium difficileInfections
| Autor: | Charlesnika T. Evans, Ronald W. Buie, Linda Poggensee, Daniel Shirley, Maria C. Mora Pinzon, Jinn Ing Liou, Swetha Ramanathan, Nasia Safdar |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Microbiology (medical) medicine.medical_specialty Adolescent genetic structures Hospitals Veterans medicine.drug_class Fulminant 030106 microbiology Antibiotics Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine Epidemiology Health care medicine Humans 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Cross Infection Clostridioides difficile business.industry Clindamycin Retrospective cohort study Odds ratio Middle Aged Clostridium difficile Community-Acquired Infections Infectious Diseases Clostridium Infections Female business medicine.drug |
| Zdroj: | Clinical Infectious Diseases. 68:1343-1350 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciy715 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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