Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia.
Clostridium difficile infection (CDI) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (CAP) is the leading indication for anti-biotic prescription in hospitals. This study assessed the incidence of and risk factors for CDI in a cohort of patients hospitalized with CAP.



We analysed data from a prospective, observational cohort of patients with CAP in Edinburgh, UK. Patients with diarrhoea were systematically screened for CDI, and risk factors were determined through time-dependent survival analysis.



Overall, 1883 patients with CAP were included, 365 developed diarrhoea and 61 had laboratory-confirmed CDI. The risk factors for CDI were: age (hazard ratio [HR], 1.06 per year; 95% confidence interval [CI], 1.03-1.08), total number of antibiotic classes received (HR, 3.01 per class; 95% CI, 2.32-3.91), duration of antibiotic therapy (HR, 1.09 per day; 95% CI, 1.00-1.19 and hospitalization status (HR, 13.1; 95% CI, 6.0-28.7). Antibiotic class was not an independent predictor of CDI when adjusted for these risk factors (P > 0.05 by interaction testing).



These data suggest that reducing the overall antibiotic burden, duration of antibiotic treatment and duration of hospital stay may reduce the incidence of CDI in patients with CAP.
Scottish Centre for Respiratory Research, University of Dundee, Dundee, DD1 9SY, UK. Electronic address: j.chalmers@dundee.ac.uk.
James D
JD
Chalmers
Department of Respiratory Medicine, University of Edinburgh, New Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. Electronic address: ahsan.akram@ed.ac.uk.
Ahsan R
AR
Akram
Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, W2 1PG, UK. Electronic address: aransinga@gmail.com.
Aran
A
Singanayagam
Microbiology Department, Leeds Teaching Hospitals & University of Leeds, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK. Electronic address: mark.wilcox@nhs.net.
Mark H
MH
Wilcox
Department of Respiratory Medicine, University of Edinburgh, New Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. Electronic address: adam.hill318@nhs.net.
Adam T
AT
Hill
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000139:chemically induced / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000150:complications* / Q000188:drug therapy; D003967:Diarrhea / Q000139:chemically induced / Q000453:epidemiology* / Q000382:microbiology; D004363:Drug Utilization; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
D000900:Anti-Bacterial Agents
Antibiotics; Clostridium difficile; Healthcare-associated infections; Macrolides; Pneumonia