title: Body mass index greater than 35 is associated with severe Clostridium difficile infection.
abstract: Obesity has been implicated in the acquisition of Clostridium difficile infections (CDI), however, no study has investigated whether there is a correlation between body mass index (BMI) and CDI severity.
  
  
  
  To determine whether obesity, as measured by BMI correlates with severe hospital-onset or community-onset CDI.
  
  
  
  Patients admitted with CDI at a tertiary-care center from January 2013 to June 2015 were identified. The cohort was stratified by onset of disease using the National Healthcare Safety Network criteria, and by severity using the 2013 American College of Gastroenterology guidelines. Multivariate logistic regression was used to determine independent predictors of severe CDI.
  
  
  
  A total of 196 met the inclusion criteria, of which 57.1% (112) met criteria for severe disease. Overall, BMI >35 kg/m2was 1.7-fold more likely to be associated with severe CDI compared to a BMI 20-35 kg/m2(P < 0.005), and was an independent predictor of severe CDI (P = 0.038). In patients with community-onset-CDI and hospital-onset-CDI, a BMI >35 kg/m2was associated with a 1.96-fold and 1.48 greater rate of severe CDI compared to a BMI 20-35 kg/m2(P = 0.004 and 0.048), and was an independent predictor of severe CDI in these cohorts (P = 0.039 and 0.027) respectively.
  
  
  
  This study has identified an association between body mass index and Clostridium difficile infection severity. A BMI>35 kg/m2is an independent risk factor for severe community-onset and hospital-onset Clostridium difficile infections.
authors: Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors: R
authors: R
authors: Mulki
authors: Department of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA.
authors: A J
authors: AJ
authors: Baumann
authors: Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors: T
authors: T
authors: Alnabelsi
authors: Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors: N
authors: N
authors: Sandhu
authors: Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors: Y
authors: Y
authors: Alhamshari
authors: Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
authors: D S
authors: DS
authors: Wheeler
authors: Division of Infectious Disease, Einstein Medical Center, Philadelphia, PA, USA.
authors: S
authors: S
authors: Perloff
authors: Division of Gastroenterology and Hepatology, Einstein Medical Center, Philadelphia, PA, USA.
authors: P O
authors: PO
authors: Katz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000639:trends