Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder.
BACKGROUND
Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D.


METHODS
This was a retrospective cohort study with data from outpatient, inpatient, and extended care settings at 83 Department of Veterans Affairs facilities from 2002 to 2009.


RESULTS
Of 1,464 cases of CDI analyzed, 315 cases (21.5%) had a first recurrence of CDI. Multivariable regression demonstrated that risk factors significantly associated with increased recurrence were concomitant fluoroquinolone use (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08-1.80), whereas concomitant tetracycline use (OR, 0.35; 95% CI: 0.14-0.90), and cerebrovascular accident (OR, 0.46; 95% CI: 0.25-0.85) were associated with decreased recurrence. A subanalysis in those with health care facility-onset CDI showed that increased length of stay postinitial CDI was a significant risk factor for recurrence as was concomitant use of fluoroquinolones and that tetracycline remained protective for recurrence.


CONCLUSIONS
Concomitant fluoroquinolone use was a risk factor for the recurrence of CDI. In contrast, tetracyclines and cerebrovascular accident were protective. Length of stay greater than 90 days from the initial CDI episode was also a risk factor for recurrence among those with health care facility-onset CDI. Future studies should focus on effective strategies to prevent these risk factors among the SCI/D population.
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr VA Hospital, Hines, IL; School of Public Health, University of Illinois, Chicago, IL. Electronic address: Swetha.Ramanathan@va.gov.
Swetha
S
Ramanathan
Department of Veterans Affairs, Research Service, Edward Hines Jr VA Hospital, Hines, IL; Department of Medicine, Loyola University Medical Center, Maywood, IL.
Stuart
S
Johnson
VA Puget Sound Health Care System, SCI QUERI, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Stephen P
SP
Burns
Cincinnati VA Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.
Stephen M
SM
Kralovic
VA Puget Sound Health Care System, SCI QUERI, Seattle, WA.
Barry
B
Goldstein
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr VA Hospital, Hines, IL; Department of Medicine, Loyola University Medical Center, Maywood, IL.
Bridget
B
Smith
Department of Veterans Affairs, Research Service, Edward Hines Jr VA Hospital, Hines, IL; Department of Medicine, Loyola University Medical Center, Maywood, IL.
Dale N
DN
Gerding
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr VA Hospital, Hines, IL; Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, IL.
Charlesnika T
CT
Evans
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000139:chemically induced / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D003967:Diarrhea / Q000139:chemically induced / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000150:complications*; D013119:Spinal Cord Injuries / Q000150:complications*; D014728:Veterans; D055815:Young Adult
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
C difficile infection; Concomitant antibiotics; First recurrence; Length of stay; Veterans Affairs