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

Factors associated with progression to hospital-onset C difficile infection in colonized patients included prior hospitalization and third-generation cephalosporin use.

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. 

Progression to HO-CDI was uncommon among colonized patients at our institution.

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.


Clement J, Barlingay G, Donnelley M, et al. Risk factors for the development of Clostridioides difficile infection in patients colonized with Clostridioides difficile. Presented at: IDWeek 2022; October 19-23; Washington, DC. Poster 402.