Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: a systematic review and meta-analysis

Luis Furuya-Kanamori, Jennifer C Stone, Justin Clark, Samantha J McKenzie, Laith Yakob, David L. Paterson, Thomas V Riley, Suhail A R Doi, Archie C Clements

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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.

Original languageEnglish
Pages (from-to)132-141
Number of pages10
JournalInfection Control and Hospital Epidemiology
Volume36
Issue number2
DOIs
Publication statusPublished - Feb 2015
Externally publishedYes

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Clostridium Infections
Clostridium difficile
Meta-Analysis
Comorbidity
Odds Ratio
Inflammatory Bowel Diseases
Renal Insufficiency
Proton Pump Inhibitors
Publications
Epidemiologic Studies
Diarrhea
Neoplasms
Diabetes Mellitus
Adrenal Cortex Hormones
Databases
Delivery of Health Care

Cite this

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. / Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection : a systematic review and meta-analysis. In: Infection Control and Hospital Epidemiology. 2015 ; Vol. 36, No. 2. pp. 132-141.
@article{12baea24bb0a465ab07e9b125547a6c2,
title = "Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: a systematic review and meta-analysis",
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.",
author = "Luis Furuya-Kanamori and Stone, {Jennifer C} and Justin Clark and McKenzie, {Samantha J} and Laith Yakob and Paterson, {David L.} and Riley, {Thomas V} and Doi, {Suhail A R} and Clements, {Archie C}",
year = "2015",
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Furuya-Kanamori, L, Stone, JC, Clark, J, McKenzie, SJ, Yakob, L, Paterson, DL, Riley, TV, Doi, SAR & Clements, AC 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, vol. 36, no. 2, pp. 132-141. https://doi.org/10.1017/ice.2014.39

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; Clements, Archie C.

In: Infection Control and Hospital Epidemiology, Vol. 36, No. 2, 02.2015, p. 132-141.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection

T2 - a systematic review and meta-analysis

AU - Furuya-Kanamori, Luis

AU - Stone, Jennifer C

AU - Clark, Justin

AU - McKenzie, Samantha J

AU - Yakob, Laith

AU - Paterson, David L.

AU - Riley, Thomas V

AU - Doi, Suhail A R

AU - Clements, Archie C

PY - 2015/2

Y1 - 2015/2

N2 - 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.

AB - 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.

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DO - 10.1017/ice.2014.39

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SN - 0899-823X

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