Health care-associated Clostridium difficile (C. difficile) infection and colonization are differentially associated with defined host and pathogen variables, according to a study published in the Nov. 3 issue of the New England Journal of Medicine.
Vivian G. Loo, M.D., from McGill University in Montreal, and colleagues investigated the bacterial and host factors related to acquiring health care-associated C. difficile infection and colonization in 4,143 patients hospitalized between March 2006 and June 2007. Data on demographic information, known risk factors, and potential confounding factors were collected. Rectal swabs or stool samples were obtained weekly. Genotypes of C. difficile isolates were determined using pulsed-field gel electrophoresis (PFGE), and serum antibody levels against C. difficile toxins A and B were determined.
The investigators found that health-care associated C. difficile infection was found in 2.8 percent, and colonization in 3 percent of the patients. Use of antibiotics and proton-pump inhibitors, and older age significantly correlated with health care-associated C. difficile infection. Use of chemotherapy, proton-pump inhibitors and H2 blockers, hospitalization in the previous two months, and presence of antibodies against toxin B correlated with health care-associated C. difficile colonization. The North American PFGE type 1 strain was found in 62.7 and 36.1 percent of the patients with health care-associated C. difficile infection and colonization, respectively.
"Our study shows differential effects of age, medication use, and host immunity and pathogen variables on health care-associated C. difficile infection and health care-associated C. difficile colonization," the authors write.
Several authors disclosed financial ties with the pharmaceutical, molecular diagnostics, and medical device industries.
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