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Risk Factors for Recurrent Clostridium difficile Infection: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  28 January 2015

Abhishek Deshpande ,
Vinay Pasupuleti ,
Priyaleela Thota ,
Chaitanya Pant ,
David D.K. Rolston ,
Adrian V. Hernandez ,
Curtis J. Donskey  and
Thomas G. Fraser
Abhishek Deshpande*
Affiliation:
Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
Vinay Pasupuleti
Affiliation:
Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
Priyaleela Thota
Affiliation:
Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
Chaitanya Pant
Affiliation:
Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas
David D.K. Rolston
Affiliation:
Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania
Adrian V. Hernandez
Affiliation:
Postgraduate and Medical Schools, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Curtis J. Donskey
Affiliation:
Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio Geriatric Research Education and Clinical Center, Cleveland VA Medical Center, Cleveland, Ohio
Thomas G. Fraser
Affiliation:
Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
*
Address correspondence to Abhishek Deshpande MD, PhD, Assistant Staff in Medicine Institute Center for Value Based Care, Cleveland Clinic, 9500 Euclid Avenue, Desk G1-40, Cleveland OH 44195 ([email protected]).
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Abstract

OBJECTIVE

An estimated 20–30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI.

DESIGN

We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated.

RESULTS

A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24–2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52–2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13–2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14–2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28–1.57; P<.00001).

CONCLUSIONS

Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.

Infect Control Hosp Epidemiol 2015;00(0): 1–9

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 4 , April 2015 , pp. 452 - 460
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Contributed equally to this study.

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