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Obesity linked to increased risk for severe C. diff infection
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Obesity, as measured by BMI, was associated with an increased risk for severe community- and hospital-onset Clostridium difficile infection, according to results from a retrospective case-control study.
“Our findings extend previous work, establishing ... high BMI[s] as independent risk factors for severe CDI,” Philip O. Katz, MD, from the division of gastroenterology and hepatology at Albert Einstein Medical Center in Philadelphia, and colleagues wrote. “Other independent risk factors identified were diabetes mellitus and prior antibiotics. Taken together, this suggests that patients with suspected CDI and risk factors for severity ... may benefit from early aggressive therapy, rather than escalating care once complications occur.”
Katz and colleagues evaluated the medical records of all 196 patients who tested positive for C. difficile at Einstein Medical Center between January 2013 and June 2015. After stratifying patients by CDI onset and severity, they performed logistic regression analysis to identify independent predictors of severe CDI.
Overall, 57.1% of patients met ACG criteria for severe CDI, and those with a BMI greater than 35 kg/m2 had a 1.7-fold higher risk for severe CDI compared with those who had a BMI of 20 kg/m2 to 35 kg/m2 (P < .005). Multivariate analysis showed a BMI greater than 35 kg/m2 was an independent predictor of severe CDI (OR = 2.79; 95% CI, 1.07–7.28).
“Interestingly, the presence of diabetes mellitus was also found to be an independent predictor of severe CDI (OR = 2.05; 95% CI, 1.03–4.06) while the presence of hyperlipidemia was not (OR = 0.58; 95% CI, 0.22–1.53),” the researchers wrote.
When stratifying patients by community- or hospital-onset CDI, a BMI greater than 35 kg/m2 was associated with a 1.96-fold greater risk for severe CDI among patients with community-onset infection (P = .004), and with a 1.48-fold greater risk for severe CDI among patients with hospital-onset infection (P = .048), compared with a BMI of 20 kg/m2 to 35 kg/m2.
“Patients with community-onset disease had a ‘J’ curve relationship between severe CDI and BMI with the percentage of severe CDI being greatest in patients with BMI [greater than] 35 kg/m2 and reaching almost 100% with BMI [greater than] 40 kg/m2,” the researchers wrote. “Interestingly, the relationship between severe CDI and BMI in patients with hospital-onset disease was ‘U’ shaped, demonstrating a higher incidence of severe CDI at both extremes of BMI.”
Multivariate analysis also showed that a BMI greater than 35 kg/m2 was an independent predictor of severe CDI in community-onset (OR = 1.33; 95% CI, 1.02-1.73) and hospital-onset CDI (OR = 1.74; 95% CI, 1.07-2.82).
It is unclear why increased BMI may be a risk factor for severe CDI, but changes in the gut microbiota and obesity-related inflammation mediators may be possible underlying mechanisms, the researchers concluded. Moreover, they suggested that the increased risk for severe CDI associated with diabetes “could be related to the increased vulnerability of diabetic patients to infection or the higher likelihood of gastrointestinal dysmotility.”
Of course, the cross-sectional study design prevents drawing conclusions about causality, and therefore prospective studies are needed to validate these findings, the researchers added. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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