Clostridium difficile infection risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The most important risk factor for the development of C. difficile infection is antibiotic use within the past 12 weeks. Although C. difficile infection has been described with almost all antibiotics, ampicillin, amoxicillin, cephalosporins, clindamycin, and fluoroquinolones are most classically and most commonly associated with development of C. difficile infection. Other important risk factors include recent hospitalization (< 12 weeks), advanced age (>65 years), immunodeficiency (primary or secondary causes), inflammatory bowel disease, and exposure to colonized/infected individuals. The association between gastric acid suppression and C. difficile infection has not been well established.
Common Risk Factors
Antibiotic Use
The most important risk factor is antibiotic use within the past 12 weeks.[1][2][3] Although C. difficile infection has been described with almost all antibiotics, the following antibiotics are most classically and most commonly associated with development of C. difficile infection[1][2][3]:
Hospitalization and Long-Term Care Facilities
- The majority of C. difficile infections are hospital-acquired.
- The risk associated with hospitalization may persist up to 12 weeks following index hospitalization.[1][2][3]
Advanced Age
- Elderly patients > 65 years have an approximately 8-fold increased risk of developing C. difficile infection compared with younger adults.[1][2][3]
Environmental Contamination
Immunodeficiency
- Immunodeficiency results in inadequate host immune responses that normally prevent the vegetation and growth of C. difficile.[1][2][3]
- Immunodeficiency may be primary or secondary. Secondary causes of immunodeficiency include chemotherapy, organ transplant and use of immunosuppressive therapy, or HIV.
Inflammatory Bowel Disease
- Inflammatory bowel disease (either Crohn's disease or ulcerative colitis) is significantly associated with increased risk of C. difficile infection.
- Hospitalized patients with IBD flare-up should always undergo diagnostic testing for C. difficile infection.
Acid Suppression
- There are multiple reports of increased risk of C. difficile infection with gastric acid suppression.[4]
- Nonetheless, the true association between gastric acid suppression and C. difficile infection is yet to be discovered, since '"C. difficile spores are acid-resistant, and any reduction in gastric acidity may not necessarily be associated with increased risk of infection.
Risk Factors by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Ampicillin, Amoxicillin, Aztreonam, Bacitracin, Carbapenem, Cefotaxime sodium, Cefprozil, Cefotetan disodium, Cefuroxime, Chloramphenicol, Clindamycin, Daptomycin, Doripenem, Lincomycin Hydrochloride, Meropenem, Metronidazole, Mupirocin, Quinupristin dalfopristin, Rifabutin, Nitrofurantoin, Oritavancin, Pantoprazole, Piperacillin, Rifampin, Streptomycin, Sulfamethoxazole/Trimethoprim (oral), Sulfamethoxazole, Tedizolid, Teicoplanin, Tetracycline, Tigecycline, Trimethoprim |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C; et al. (2013). "Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011". JAMA Intern Med. 173 (14): 1359–67. doi:10.1001/jamainternmed.2013.7056. PMID 23780507.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Leffler DA, Lamont JT (2009). "Treatment of Clostridium difficile-associated disease". Gastroenterology. 136 (6): 1899–912. doi:10.1053/j.gastro.2008.12.070. PMID 19457418.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Leffler DA, Lamont JT (2015). "Clostridium difficile infection". N Engl J Med. 372 (16): 1539–48. doi:10.1056/NEJMra1403772. PMID 25875259.
- ↑ Dial S, Delaney JA, Barkun AN, Suissa S (2005). "Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease". JAMA. 294 (23): 2989–95. doi:10.1001/jama.294.23.2989. PMID 16414946.