title: Host and pathogen factors for Clostridium difficile infection and colonization.
abstract: BACKGROUND
  Clostridium difficile infection is the leading cause of health care-associated diarrhea, and the bacterium can also be carried asymptomatically. The objective of this study was to identify host and bacterial factors associated with health care-associated acquisition of C. difficile infection and colonization.
  
  
  METHODS
  We conducted a 15-month prospective study in six Canadian hospitals in Quebec and Ontario. Demographic information, known risk factors, potential confounding factors, and weekly stool samples or rectal swabs were collected. Pulsed-field gel electrophoresis (PFGE) was performed on C. difficile isolates to determine the genotype. Levels of serum antibodies against C. difficile toxins A and B were measured.
  
  
  RESULTS
  A total of 4143 patients were included in the study; 117 (2.8%) and 123 (3.0%) had health care-associated C. difficile infection and colonization, respectively. Older age and use of antibiotics and proton-pump inhibitors were significantly associated with health care-associated C. difficile infection. Hospitalization in the previous 2 months; use of chemotherapy, proton-pump inhibitors, and H(2) blockers; and antibodies against toxin B were associated with health care-associated C. difficile colonization. Among patients with health care-associated C. difficile infection and those with colonization, 62.7% and 36.1%, respectively, had the North American PFGE type 1 (NAP1) strain.
  
  
  CONCLUSIONS
  In this study, health care-associated C. difficile infection and colonization were differentially associated with defined host and pathogen variables. The NAP1 strain was predominant among patients with C. difficile infection, whereas asymptomatic patients were more likely to be colonized with other strains. (Funded by the Consortium de Recherche sur le Clostridium difficile.).
authors: Department of Microbiology, McGill University Health Centre, 687 Pine Ave. W., Rm. L5.06, Montreal, QC H3A 1A1, Canada.
authors: Vivian G
authors: VG
authors: Loo
authors: Anne-Marie
authors: AM
authors: Bourgault
authors: Louise
authors: L
authors: Poirier
authors: François
authors: F
authors: Lamothe
authors: Sophie
authors: S
authors: Michaud
authors: Nathalie
authors: N
authors: Turgeon
authors: Baldwin
authors: B
authors: Toye
authors: Axelle
authors: A
authors: Beaudoin
authors: Eric H
authors: EH
authors: Frost
authors: Rodica
authors: R
authors: Gilca
authors: Paul
authors: P
authors: Brassard
authors: Nandini
authors: N
authors: Dendukuri
authors: Claire
authors: C
authors: Béliveau
authors: Matthew
authors: M
authors: Oughton
authors: Ivan
authors: I
authors: Brukner
authors: Andre
authors: A
authors: Dascal
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000139:chemically induced / Q000382:microbiology*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000382:microbiology*; D003967:Diarrhea / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D037521:Virulence Factors / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D037521:Virulence Factors