A Case-control Study of Community-associated Clostridium difficile Infection: No Role for Proton Pump Inhibitors - 19/08/11
, Becky A. Miller, MD a, Kimberly B. Zuzak, MD a, Brian W. Pence, PhD, MPH c, d, Ashley J. Mayo, MSPH e, Bradly P. Nicholson, PhD b, Preeta K. Kutty, MD, MPH f, g, L. Clifford McDonald, MD f, Christopher W. Woods, MD, MPH a, b
Requests for reprints should be addressed to Susanna Naggie, MD, Division of Infectious Diseases, Duke University Medical Center, Box 102359 DUMC, Durham, NC 27710Abstract |
Background |
The epidemiology of community-associated Clostridium difficile infection is not well known. We performed a multicenter, case-control study to further describe community-associated C. difficile infection and assess novel risk factors.
Methods |
We conducted this study at 5 sites from October 2006 through November 2007. Community-associated C. difficile infection included individuals with diarrhea, a positive C. difficile toxin, and no recent (12 weeks) discharge from a health care facility. We selected controls from the same clinics attended by cases. We collected clinical and exposure data at the time of illness and cultured residual stool samples and performed ribotyping.
Results |
Of 1041 adult C. difficile infections, 162 (15.5%) met criteria for community-associated: 66 case and 114 control patients were enrolled. Case patients were relatively young (median 64 years), female (56%), and frequently required hospitalization (38%). Antimicrobials, malignancy, exposure to high-risk persons, and remote health care exposure were independently associated with community-associated C. difficile infection. In 40% of cases, we could not confirm recent antibiotic exposure. Stomach-acid suppressants were not associated with community-associated infection, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors appeared protective. Prevalence of the hypervirulent NAP-1/027 strain was infrequent (17%).
Conclusions |
Community-associated C. difficile infection resulted in a substantial health care burden. Antimicrobials are a significant risk factor for community-associated infection. However, other unique factors also may contribute, including person-to-person transmission, remote health care exposures, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors. A role for stomach-acid suppressants in community-associated C. difficile infection is not supported.
Le texte complet de cet article est disponible en PDF.Keywords : Clostridium difficile, Community, Diarrhea, Infection, Proton pump inhibitor
Plan
| Funding: American College of Gastroenterology. |
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| Conflict of Interest: All authors report no conflict of interest. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention. |
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| Authorship: Author participation: Study design: S.N., P.K., C.M., C.W.; data collection: S.N., B.M., K.Z.; data analysis: S.N., B.P., A.M., C.W.; laboratory analysis: B.N.; access to data, manuscript writing and review: all authors. |
Vol 124 - N° 3
P. 276.e1-276.e7 - mars 2011 Retour au numéro
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