Risk Factors for Progression to Hospital-Onset C difficile Infection in Colonized Patients

Among hospitalized patients colonized with Clostridioides difficile, risk factors found to be associated with progression to C difficile infection (CDI) included malignancy, intensive care unit (ICU) admission, and use of immunosuppressants and third-generation cephalosporin. These study results were presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

For this retrospective cohort study, patients (N=2150) hospitalized between 2017 and 2020 who were colonized with C difficile were evaluated to determine the prevalence of hospital-onset CDI and its associated risk factors. Colonization was confirmed via polymerase chain reaction testing of anorectal swab specimens collected at hospital admission. Patients who were CDI toxin positive (n=109) were matched in a 1:3 fashion with those who were CDI toxin negative (n=327). Descriptive analyses were used to assess the patient population, and a univariate analysis was performed to determine hospital-onset CDI risk factors.

Among 109 patients included in the final analysis, the median age was 64 years, and 50.7% were men. Of the 2150 patients included in the prematched analysis who were colonized with C difficile, 69 (3.2%) developed hospital-onset CDI. 

The researchers compared patients who were CDI toxin positive and negative to determine risk factors associated with hospital-onset CDI. Results showed ICU admission (odds ratio [OR], 5.14; 95% CI, 2.47-10.73; P <.0001), use of third-generation cephalosporins within the previous 3 months (OR, 4.5; 95% CI, 1.12-18.13; P =.03), and immunosuppressant use (OR, 3.33; 95% CI, 1.14-9.78; P =.03) were significantly associated with progression to hospital-onset CDI.

Other factors significantly associated with hospital-onset CDI progression included antibiotic use in the previous month (OR, 3.23; 95% CI, 1.59-6.56; P =.001), malignancy (OR, 2.89; 95% CI, 1.24-6.75; P =.01), hospitalization in the previous month (OR, 2.2; 95% CI, 1.1-4.38; P =.03), and antibiotic use within the previous 3 months (OR, 2.16; 95% CI, 1.07-4.35; P =.03).

This study was limited by its single center design. These findings should be confirmed among an independent cohort.

“Progression to HO-CDI [hospital-onset CDI] was uncommon among colonized patients at our institution,” the researchers concluded.