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Risk factors for recurrent Clostridium difficile infection in a tertiary hospital in Israel

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Abstract

To estimate the rate and identified risk factors for recurrent Clostridium difficile infection (rCDI) in Israel. We conducted a retro-prospective case-control study of all adult (age ≥ 18 years) patients with an initial episode of CDI (iCDI) at Tel Aviv Sourasky Medical Center from January 1, 2012 to December 31, 2014. We collected demographic, clinical, and epidemiological information for patients who were classified as recurrent (cases) and non-recurrent (control) groups. In total, 648 patients with iCDI were identified in the study. During the 36-month study period, 82 (12.7%) patients had at least one rCDI identified. We identified several factors as independent variables significantly associated with recurrent CDI: functional disability, severity of the initial infection, continuous non-Clostridium difficile antibiotic treatment with third-generation cephalosporins or clindamycin, and iCDI treatment with metronidazole and vancomycin; however, neutropenia had high measure of effect as a predictor for rCDI (adjusted odds ratio, 7.9; 95% confidence interval, 1.27–49.58; p = 0.026). The identification of the main modifiable risk factors for recurrent CDI, continuous non-Clostridium difficile antibiotics after diagnosis of the initial infection, and antibiotic treatment with third-generation cephalosporins or clindamycin are critical in reducing the spread of recurrent infection with Clostridium difficile in hospital.

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Author information

Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel

    Wasef Na’amnih, Amos Adler, Dani Cohen & Yehuda Carmeli

  2. Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, 64239, Tel Aviv, Israel

    Amos Adler, Tamar Miller-Roll & Yehuda Carmeli

  3. Department of Geriatric Rehabilitation, Tel-Aviv Sourasky Medical Center, 64239, Tel Aviv, Israel

    Wasef Na’amnih

Authors
  1. Wasef Na’amnih
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  2. Amos Adler
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  3. Tamar Miller-Roll
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  4. Dani Cohen
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  5. Yehuda Carmeli
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Correspondence to Wasef Na’amnih.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Na’amnih, W., Adler, A., Miller-Roll, T. et al. Risk factors for recurrent Clostridium difficile infection in a tertiary hospital in Israel. Eur J Clin Microbiol Infect Dis 37, 1281–1288 (2018). https://doi.org/10.1007/s10096-018-3247-1

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  • DOI: https://doi.org/10.1007/s10096-018-3247-1

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