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. 2017 Oct 26;4(4):ofx171.
doi: 10.1093/ofid/ofx171. eCollection 2017 Fall.

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Alice Y Guh  1 , Susan Hocevar Adkins  1 , Qunna Li  1 , Sandra N Bulens  1 , Monica M Farley  2   3   4 , Zirka Smith  3   4   5 , Stacy M Holzbauer  6   7 , Tory Whitten  6 , Erin C Phipps  8 , Emily B Hancock  8 , Ghinwa Dumyati  9 , Cathleen Concannon  9 , Marion A Kainer  10 , Brenda Rue  10 , Carol Lyons  11 , Danyel M Olson  11 , Lucy Wilson  12 , Rebecca Perlmutter  12 , Lisa G Winston  13 , Erin Parker  14 , Wendy Bamberg  15 , Zintars G Beldavs  16 , Valerie Ocampo  16 , Maria Karlsson  1 , Dale N Gerding  17   18 , L Clifford McDonald  1
Affiliations

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Alice Y Guh et al. Open Forum Infect Dis. .

Abstract

Background: An increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.

Methods: We enrolled participants from 10 US sites during October 2014-March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.

Results: Of 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure-that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13-321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01-311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77-340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76-340.05),-emergency department visit (AmOR, 17.37; 95% CI, 1.99-151.22), white race (AmOR 7.67; 95% CI, 2.34-25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20-19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24-118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27-20.79) were associated with CA-CDI.

Conclusions: Antibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.

Keywords: community-associated Clostridium difficile infection.

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