title: Clostridium difficile infection among hospitalized HIV-infected individuals: epidemiology and risk factors: results from a case-control study (2002-2013).
abstract: BACKGROUND
  HIV infection is a risk factor for Clostridium difficile infection (CDI) yet the immune deficiency predisposing to CDI is not well understood, despite an increasing incidence of CDI among such individuals. We aimed to estimate the incidence and to evaluate the risk factors of CDI among an HIV cohort in Italy.
  
  
  METHODS
  We conducted a retrospective case-control (1:2) study. Clinical records of HIV inpatients admitted to the National Institute for Infectious Disease "L. Spallanzani", Rome, were reviewed (2002-2013).
  
  
  METHODS
  HIV inpatients with HO-HCFA CDI, and controls: HIV inpatients without CDI, were matched by gender and age. Logistic regression was used to identify risk factors associated with CDI.
  
  
  RESULTS
  We found 79 CDI episodes (5.1 per 1000 HIV hospital admissions, 3.4 per 10000 HIV patient-days). The mean age of cases was 46 years. At univariate analysis factors associated with CDI included: antimycobacterial drug exposure, treatment for Pneumocystis pneumonia, acid suppressant exposure, previous hospitalization, antibiotic exposure, low CD4 cell count, high Charlson score, low creatinine, low albumin and low gammaglobulin level. Using multivariate analysis, lower gammaglobulin level and low serum albumin at admission were independently associated with CDI among HIV-infected patients.
  
  
  CONCLUSIONS
  Low gammaglobulin and low albumin levels at admission are associated with an increased risk of developing CDI. A deficiency in humoral immunity appears to play a major role in the development of CDI. The potential protective role of albumin warrants further investigation.
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. stefano932@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Bella
authors.affiliation: Department of Medical Microbiology and Infection Control, University Medical Centre, Groeningen, The Netherlands. alex.friedrich@umcg.nl.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Friedrich
authors.affiliation: Department of Internal Medicine, Manacor Hospital, Palma of Majorca, Spain. egalmodovar@gmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Almodóvar
authors.affiliation: Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy. serenagallone@gmail.com.
authors.forename: Maria Serena
authors.initials: MS
authors.lastname: Gallone
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. fabrizio.taglietti@inmi.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Taglietti
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. simone.topino@inmi.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Topino
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. vincenzo.galati@inmi.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Galati
authors.affiliation: University of Sheffield, Sheffield, UK. e.johnson@sheffield.ac.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Johnson
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. silvia.darezzo@inmi.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: D'Arezzo
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy. nicola.petrosillo@inmi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D007410:Intestinal Diseases; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents