Number of Antibiotics Used, Neoplasia History Associated With Recurrent C diff Infection

Patients who received more than 3 types of antibiotics in the year prior to C diff onset were more likely to experience a reoccurrence of C diff infection.

Both the number of types of antibiotics used in the year prior to first episode of Clostridioides difficile infection and a history of neoplasia are associated with 4-fold increased risk for recurrent C diff episodes, according to data published in the European Journal of Clinical Microbiology.

A case control study using data from 2006 to 2016 was performed and included patients admitted to the hospital with C diff infection that received any antibiotic treatment during the year before infection onset. The characteristics of C diff infection in a Spanish third level hospital were described first; then, first cases of C diff infection that reoccurred were compared with cases that did not reoccur.  A total of 110 cases in 94 individuals was included.

The number of first C diff infection episodes that later reoccurred was 12.7%. Two factors associated with higher reoccurrence risk were receiving more than 3 types of antibiotics during the year before the onset of C diff symptoms (odds ratio [OR], 4.69; 95% CI, 1.01–21.78) and past history of neoplasia (OR, 4.58; 95% CI, 1.00–20.98).

In a univariate analysis, the number of previous hospital admissions was associated with the development of recurrences (P <.05). There were no differences observed related to the type of antibiotic used immediately before the C diff episode, nor with the treatment received.

Investigators were surprised by the low percentage of cases — only 23.6% — for which contact precautions were recorded in the medical history. According to the researchers, these are basic preventive measures for C diff infection, but these measures are often overlooked.

“Although this study is a retrospective analysis, the data were collected from electronic medical records created for the purpose of patient care, possibly leading to an information bias,” they noted. Therefore, it is possible that contact precautions were implemented and just not recorded. The study was also limited in that it was retrospective and conducted at a single center. Only hospitalized patients in internal medicine service were included, potentially leading to a selection bias.

In this cohort the 2 most important independent risk factors for C diff infection recurrence were the number of antibiotics used within the year prior to the first C diff episode and a personal history of neoplasia. Both represented an approximate 4-fold risk. No associations were observed regarding the last antibiotic regimen that the patient received right before the onset of the first episode or the treatment received for the first C diff infection.


Marques-Afonso AT, Fernández-Castro I, Vázquez-Agra N, et al. Analysis of predisposing factors for the development of Clostridioides difficile infection recurrence [published online July 8, 2020]. Eur J Clin Microbiol Infect Dis. doi:10.1007/s10096-020-03982-w