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. 2025 May 16;14(1):53.
doi: 10.1186/s13756-025-01571-0.

Risk factors for Clostridioides difficile infection caused by ribotype 027 strains in the Veterans Affairs Healthcare System: a matched case-control study

Sandra Y Silva  1 , Brigid M Wilson  2   3 , Curtis J Donskey  4   5
Affiliations

Risk factors for Clostridioides difficile infection caused by ribotype 027 strains in the Veterans Affairs Healthcare System: a matched case-control study

Sandra Y Silva et al. Antimicrob Resist Infect Control. .

Abstract

Background: In case-control studies, a variety of factors have been associated with Clostridioides difficile infection (CDI) due to the epidemic ribotype 027 strain. However, many studies have been limited due to small sample size and inclusion of only one facility.

Methods: Using a nationwide cohort of hospitalized patients in the Veterans Affairs (VA) Healthcare System, we conducted a retrospective, 1:3 matched case-control study of patients with CDI due to the ribotype 027 strain versus non-027 strains from October 1, 2008, to September 30, 2020. Controls were matched to cases by health care facility and year of diagnosis. Multivariate logistic regression was used to identify risk factors for CDI due to the 027 strain.

Results: A total of 3,353 cases were matched to 10,059 controls in 84 VA facilities. CDI due to the ribotype 027 strain was independently associated with prior macrolide or fluoroquinolone exposure, decreased functional capability, methicillin-resistant Staphylococcus aureus nasal colonization, age >65 years, white blood cell count >11,000 cells/mm3, and serum albumin < 3.5 g/dl.

Conclusion: Antimicrobial stewardship interventions focused on fluoroquinolones and macrolides could be beneficial in reducing the risk for infection due to the ribotype 027 C. difficile strain. Several other factors could potentially be used to identify patients at increased risk for CDI due to the ribotype 027 strain, but further studies are needed to assess their utility in clinical settings.

Keywords: Clostridioides difficile; Fluoroquinolones; Ribotype 027; Risk factors; Stewardship.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Competing interests: C.J.D has received research grants from Clorox and Pfizer unrelated to the current study. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study participants
Fig. 2
Fig. 2
Percentages of prior exposure to different classes of high-risk antibiotics among case patients with Clostridioides difficile infection (CDI) due to the ribotype 027 strain and control patients with CDI due to non-027 strains
Fig. 3
Fig. 3
Odd ratios and 95% confidence intervals (CI) of independent risk factors associated with Clostridioides difficile infection (CDI) due to the ribotype 027 strain for healthcare-associated (A) and community-associated CDI
See this image and copyright information in PMC

References

    1. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433–41. - PubMed
    1. He M, Miyajima F, Roberts P, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013;45:109–13. - PMC - PubMed
    1. Owens RC Jr, Donskey CJ, Gaynes RP, et al. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S19-31. - PubMed
    1. Wieczorkiewicz JT, Lopansri BK, Cheknis A, Osmolski JR, Hecht DW, Gerding DN, Johnson S. Fluoroquinolone and macrolide exposure predict Clostridiumdifficile infection with the highly fluoroquinolone- and macrolide-resistant epidemic C. difficile strain BI/NAP1/027. Antimicrob Agents Chemother. 2015;60:418–23. - PMC - PubMed
    1. Adams DA, Riggs MM, Donskey CJ. Effect of fluoroquinolone treatment on growth of and toxin production by epidemic and nonepidemic Clostridium difficile strains in the cecal contents of mice. Antimicrob Agents Chemother. 2007;51:2674–8. - PMC - PubMed

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