title: Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort.
abstract: Clostridium difficile infection (CDI) is a serious medical condition that is associated with substantial morbidity and mortality. Identification of risk factors associated with CDI and prompt recognition of patients at risk is key to successfully preventing CDI.
  
  
  
  A 3-year prospective, observational, cohort study was conducted in a French university hospital and a nested case-control study was performed to identify risk factors for CDI. Inpatients aged 18 years or older, suffering from diarrhea suspected to be related to CDI, were asked to participate.
  
  
  
  A total of 945 patients were included, of which 233 cases had a confirmed CDI. CDI infection was more common in men (58.4%) (P = 0.04) compared with patients with diarrhea not related to C. difficile. Previous hospitalization (P < 0.001), prior treatment with antibiotics (P = 0.001) or antiperistaltics (P = 0.002), liver disease (P = 0.003), malnutrition (P < 0.001), and previous CDI (P < 0.001) were significantly more common in patients with CDI. Multivariate logistic regression analysis showed that exposure to antibiotics in the last 60 days (especially third generation cephalosporins and penicillins with β-lactamase inhibitor), chronic renal or liver disease, malnutrition or previous CDI, were associated with an independent high risk of CDI. Age was not related with CDI.
  
  
  
  This study showed that antibiotics and some comorbid conditions were predictors of CDI. Patients at high risk of acquiring CDI at the time of admission may benefit from careful monitoring of antibiotic prescriptions and early attention to infection control issues. In future, these "high-risk" patients may benefit from novel agents being developed to prevent CDI.
authors.affiliation: Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France. Electronic address: naghamkhanafer@hotmail.com.
authors.forename: Nagham
authors.initials: N
authors.lastname: Khanafer
authors.affiliation: Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.affiliation: Pierre and Marie Curie University, Paris, France; National Reference Laboratory for C. difficile, Saint Antoine Hospital, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
authors.affiliation: Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France. Electronic address: naghamkhanafer@hotmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Luxemburger
authors.affiliation: Sanofi Pasteur, Lyon, France.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Demont
authors.affiliation: Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France. Electronic address: naghamkhanafer@hotmail.com.
authors.forename: Monique
authors.initials: M
authors.lastname: Hulin
authors.affiliation: Laboratory of Micro-biology Est, Hospices Civils de Lyon, Bron, France
authors.forename: Olivier
authors.initials: O
authors.lastname: Dauwalder
authors.affiliation: Laboratory of Micro-biology Est, Hospices Civils de Lyon, Bron, France
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Xavier
authors.initials: X
authors.lastname: Barth
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Malik
authors.initials: M
authors.lastname: Bertrand
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Carole
authors.initials: C
authors.lastname: Burillon
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Roland
authors.initials: R
authors.lastname: Chapurlat
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Michel
authors.initials: M
authors.lastname: Chuzeville
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Brigitte
authors.initials: B
authors.lastname: Comte
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: François
authors.initials: F
authors.lastname: Disant
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Michel Henry
authors.initials: MH
authors.lastname: Fessy
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Christian
authors.initials: C
authors.lastname: Gouillat
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Laurent
authors.initials: L
authors.lastname: Juillard
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Patrick
authors.initials: P
authors.lastname: Lermusiaux
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Olivier
authors.initials: O
authors.lastname: Monneuse
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Jacques
authors.initials: J
authors.lastname: Ninet
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Poulet
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmele
authors.affiliation: Groupement Hospitalier Edouard Herriot, Hos-
  pices Civils de Lyon, Lyon, France
authors.forename: Karim
authors.initials: K
authors.lastname: Tazarourte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile infection; Predictors; Risk factors