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

Furuya-Kanamori, Luis, Stone, Jennifer C., Clark, Justin, McKenzie, Samantha J., Yakob, Laith, Paterson, David L., Riley, Thomas V., Doi, Suhail A. R. and Clements, Archie C. (2015) Comorbidities, exposure to medications, and the risk of community-acquired clostridium difficile infection: a systematic review and meta-analysis. Infection Control and Hospital Epidemiology, 36 2: 132-141. doi:10.1017/ice.2014.39

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Author Furuya-Kanamori, Luis
Stone, Jennifer C.
Clark, Justin
McKenzie, Samantha J.
Yakob, Laith
Paterson, David L.
Riley, Thomas V.
Doi, Suhail A. R.
Clements, Archie C.
Title Comorbidities, exposure to medications, and the risk of community-acquired clostridium difficile infection: a systematic review and meta-analysis
Formatted title
Comorbidities, exposure to medications, and the risk of community-acquired clostridium difficile infection: a systematic review and meta-analysis
Journal name Infection Control and Hospital Epidemiology   Check publisher's open access policy
ISSN 0899-823X
1559-6834
Publication date 2015-02
Year available 2014
Sub-type Article (original research)
DOI 10.1017/ice.2014.39
Open Access Status File (Publisher version)
Volume 36
Issue 2
Start page 132
End page 141
Total pages 10
Place of publication New York, NY, United States
Publisher Cambridge University Press
Collection year 2015
Language eng
Formatted abstract
Background: 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.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 22 Dec 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2015 Collection
School of Public Health Publications
 
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