Outpatient antibiotics, ED visits linked with community-acquired C. difficile

Findings published in Open Forum Infectious Diseases showed that outpatient antibiotic use is a major risk factor for community-acquired Clostridium difficile infection.

“There’s a lot of work that needs to be done in terms of improving outpatient prescribing practices and making sure that providers are appropriately prescribing antibiotics,” Alice Y. Guh, MD, MPH, of the division of health care quality promotion at the CDC, said in a press release accompanying the study. “Health care-associated C. difficile infection is still a huge burden, but there is increasingly more recognition that community-associated C. difficile (CA-CDI) can occur. Outpatient antibiotic use is a risk factor, and we need to improve antibiotic stewardship not just in inpatient settings but also outpatient settings.”

The researchers performed a case-control study of 226 pairs of patients at 10 sites in the United States from October 2014 to March 2015. Adults with confirmed C. difficile infection were matched with one uninfected control. Guh and colleagues interviewed patients about relevant exposures and performed multivariate condition logistic regression analysis.

Most participants were female (70.4%) and aged at least 60 years (52.2%). Compared with controls, more patients had received prior outpatient health care (82.1% vs. 57.9%) and exposure to antibiotics (62.2% vs. 10.3%), Guh and colleagues reported. Multivariate analysis showed that exposure to several antibiotics were linked with community-acquired C. difficile, including cephalosporin (adjusted OR = 19.02; 95% CI, 1.13-321.39), clindamycin (aOR = 35.31; 95% CI, 4.01-311.14), fluoroquinolone (aOR = 30.71; 95% CI, 2.77-340.05) and beta-lactam and/or beta-lactamase inhibitor combinations (aOR = 9.87; 95% CI, 2.76-340.05).

ED visits (aOR = 17.37; 95% CI, 1.99-151.22), white race (aOR = 7.67; 95% CI, 2.34-25.2), cardiac disease (aOR = 4.87; 95% CI, 1.2-19.8), chronic kidney disease (aOR = 12.12; 95% CI, 1.23-118.89) and inflammatory bowel disease (aOR = 5.13; 95% CI, 1.27-20.79) were also associated with community-acquired C. difficile, the researchers wrote.

“The study evaluated several potential risk factors and confirmed that antibiotic exposure remains a primary risk factor for community-associated C. difficile infection,” Guh told Infectious Disease News. “It also found that ED visits could independently increase the risk of community-associated C. difficile infection suggesting that additional efforts are needed to explore the potential role of EDs and similar types of outpatient settings in the environmental transmission of C. difficile.”

 – by Andy Polhamus

Disclosures: Guh reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.