Comorbidities, exposure to medications, and the risk of community-acquired clostridium difficile infection: a systematic review and meta-analysis

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dc.contributor.authorFuruya-Kanamori, L.
dc.contributor.authorStone, J.C.
dc.contributor.authorClark, J.
dc.contributor.authorMcKenzie, S.J.
dc.contributor.authorYakob, L.
dc.contributor.authorPaterson, D.L.
dc.contributor.authorRiley, T.V.
dc.contributor.authorDoi, S.A.R.
dc.contributor.authorClements, A.C.
dc.date.issued2015
dc.description.abstractBackground: Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. Methods: A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted. Results: Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80-10.04) and corticosteroid (1.81; 1.15-2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52-9.12), renal failure (2.64; 1.23-5.68), hematologic cancer (1.75; 1.02-5.68), and diabetes mellitus (1.15; 1.05-1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years. Conclusions: Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
dc.description.statementofresponsibilityLuis Furuya-Kanamori, Jennifer C. Stone, Justin Clark, Samantha J. McKenzie, Laith Yakob, David L. Paterson ... et al.
dc.identifier.citationInfection Control and Hospital Epidemiology, 2015; 36(2):132-141
dc.identifier.doi10.1017/ice.2014.39
dc.identifier.issn0899-823X
dc.identifier.issn1559-6834
dc.identifier.orcidStone, J.C. [0000-0002-3787-6175] [0000-0002-7848-1401]
dc.identifier.urihttps://hdl.handle.net/2440/133512
dc.language.isoen
dc.publisherCambridge University Press
dc.rights© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved
dc.source.urihttps://doi.org/10.1017/ice.2014.39
dc.subjectEnterocolitis, Pseudomembranous
dc.subjectComorbidity
dc.subjectUnited States
dc.subjectEurope
dc.subjectRenal Insufficiency
dc.subjectProton Pump Inhibitors
dc.subject.meshHumans
dc.subject.meshClostridium difficile
dc.subject.meshEnterocolitis, Pseudomembranous
dc.subject.meshCommunity-Acquired Infections
dc.subject.meshHematologic Neoplasms
dc.subject.meshInflammatory Bowel Diseases
dc.subject.meshDiabetes Mellitus
dc.subject.meshAdrenal Cortex Hormones
dc.subject.meshAnti-Bacterial Agents
dc.subject.meshRisk Factors
dc.subject.meshComorbidity
dc.subject.meshUnited States
dc.subject.meshEurope
dc.subject.meshRenal Insufficiency
dc.subject.meshProton Pump Inhibitors
dc.subject.meshClostridioides difficile
dc.titleComorbidities, exposure to medications, and the risk of community-acquired clostridium difficile infection: a systematic review and meta-analysis
dc.typeJournal article
pubs.publication-statusPublished

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