Risk Factors for C. difficile Infection
Medication Use
The risk factors for C. difficile infection include antibiotic use (particularly cephalosporins, fluoroquinolones, clindamycin and certain penicillins) and the use of acid-suppressant medications such as proton-pump inhibitors (PPI) and H2-receptor antagonists (15, 16). Those that have a weakened or suppressed immune system due to treatments such as chemotherapy are at higher risk for infection, especially during a hospital stay (15, 17).
Recent Hospitalization
Recent hospitalization is also a risk factor, due to increased exposure to those that may carry or are infected with C. difficile (15). It is estimated that almost 20% of people who are hospitalized and up to 50% of people in long-term care facilities are asymptomatic carriers [people that do not show any symptoms, such as diarrhea] of C. difficile (8, 18).
Underlying Conditions and Age
The risk of becoming infected with C. difficile increases sharply with age; in people who are 65 years old older, the risk is 10 times greater (6, 16, 19). Age is also a significant risk factor for an increase in the severity and mortality rate of C. difficile infection (16).
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Risk of infection is also greater in people who are immunosuppressed due to cancer and or who have recently undergone gastrointestinal surgeries (7, 16). Previous infection with C. difficile places patients at much higher risk to being re-infected, which known as a recurrent C. difficile infection (7, 16, 20). Similarly, those with conditions such as chronic kidney disease or inflammatory bowel disease [ulcerative colitis or Crohn’s disease with colitis] are at higher risk (7, 16). Patients who have colitis from inflammatory bowel disease may develop a C. difficile infection even if there is no prior antibiotic treatment (16). Additional risk factors include obesity, cirrhosis, and transplantation of solid organs and hematopoietic stem cells (21, 22).
Out of these factors, antibiotic use is the most widely recognized and modifiable risk factor.
References
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7. Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013;173(14):1359-67.
8. Jury LA, Sitzlar B, Kundrapu S, Cadnum JL, Summers KM, Muganda CP, et al. Outpatient healthcare settings and transmission of Clostridium difficile. PloS One. 2013;8(7):e70175-e.
15. Mullish BH, Williams HR. Clostridium difficile infection and antibiotic-associated diarrhoea. Clin Med (Lond). 2018;18(3):237-41.
16. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015;372(16):1539-48.
17. Kamthan AG, Bruckner HW, Hirschman SZ, Agus SG. Clostridium difficile diarrhea induced by cancer chemotherapy. Arch Intern Med. 1992;152(8):1715-7.
18. Depestel DD, Aronoff DM. Epidemiology of Clostridium difficile infection. J Pharm Pract. 2013;26(5):464-75.
19. Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. Jama. 2015;313(4):398-408.
20. Kyne L, Sougioultzis S, McFarland LV, Kelly CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol. 2002;23(11):653-9.
21. Yan D, Chen Y, Lv T, Huang Y, Yang J, Li Y, et al. Clostridium difficile colonization and infection in patients with hepatic cirrhosis. J Med Microbiol. 2017;66(10):1483-8.
22. Bishara J, Farah R, Mograbi J, Khalaila W, Abu-Elheja O, Mahamid M, et al. Obesity as a risk factor for Clostridium difficile infection. Clin Infect Dis. 2013;57(4):489-93.