Clostridium difficile infection risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Common Risk Factors
Antibiotic Use
The most important risk factor is antibiotic use. Although C. difficile infection has been described with almost all antibiotics, the following antibiotics are classically and most commonly associated with development of C. difficile infection:
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.
Advanced Age
- Elderly patients > 65 years have an approximately 8-fold increased risk of developing C. difficile infection compared with younger adults.
Environmental Contamination
- Exposure to infected or colonized host increases the risk of C. difficile infection.
Chemotherapy
- Chemotherapy-associated immunodeficiency results in inadequate host immune responses that normally prevent the vegetation and growth of C. difficile.
Immunodeficiency
- Immunodeficiency results in inadequate host immune responses that normally prevent the vegetation and growth of C. difficile.
Acid Suppression
- There are multiple reports of increased risk of C. difficile infection with gastric acid suppression.(28)
- 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.
Inflammatory Bowel Disease
Organ Transplantation
- Immunosuppressive therapy needed among organ transplant recipients results in acquired immunodeficiency, which results in inadequate host immune responses that normally prevent the vegetation and growth of C. difficile.
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, 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 |