Volume 29, Number 5—May 2023
CME ACTIVITY - Synopsis
Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015–2020
Chinenye M. Okafor, Paula Clogher, Danyel Olson, Linda Niccolai, and James Hadler
Table 2
Clinical characteristics of persons with incident CDI, stratified by occurrence of recurrent CDI, New Haven County, Connecticut, USA, 2015–2020*
| Characteristic | Total | Recurrent CDI, n = 515 | No recurrent CDI, n = 3,786 | p value |
|---|---|---|---|---|
| Epidemiologic class | ||||
| HCFO | 610 (14.2) | 83 (16.1) | 527 (13.9) | NS |
| CO-HCFA | 1,234 (28.7) | 174 (33.8) | 1,060 (28.0) | 0.006 |
| CA |
2,457 (57.1) |
258 (50.1) |
2,199 (58.1) |
<0.001 |
| Medical history | ||||
| Previous CDI | 837 (19.5) | 101 (19.6) | 736 (19.4) | NS |
| Immunocompromised | 1,397 (32.5) | 182 (35.3) | 1,215 (32.1) | NS |
| Cerebrovascular accident | 320 (7.4) | 48 (9.3) | 272 (7.2) | NS |
| Cognitive impairment or dementia | 337 (7.8) | 49 (9.5) | 288 (7.6) | NS |
| Malignancy | 903 (21.0) | 144 (28.0) | 759 (20.1) | <0.001 |
| HIV without AIDS | 32 (0.7) | 7 (1.4) | 25 (0.7) | NS |
| Diabetes mellitus | 1,024 (23.8) | 127 (24.7) | 897 (23.7) | NS |
| Chronic obstructive pulmonary disease | 790 (18.4) | 88 (17.1) | 702 (18.5) | NS |
| Chronic liver disease | 229 (5.3) | 27 (5.2) | 202 (5.3) | NS |
| Heart failure | 544 (12.7) | 67 (13.0) | 477 (12.6) | NS |
| Myocardial infarction | 261 (6.1) | 39 (7.6) | 222 (5.9) | NS |
| Peripheral vascular disease | 213 (5.0) | 33 (6.4) | 180 (4.8) | NS |
| Connective tissue disease | 184 (4.3) | 21 (4.1) | 163 (4.3) | NS |
| Gastrointestinal disease | 809 (18.8) | 88 (17.1) | 721 (19.0) | NS |
| Peptic ulcer disease | 71 (1.7) | 8 (1.6) | 63 (1.7) | NS |
| Morbid obesity |
149 (3.5) |
20 (3.9) |
129 (3.4) |
NS |
| Medication history prior to incident CDI | ||||
| Proton pump inhibitors | 1,487 (39.9) | 190 (41.0) | 1,297 (39.7) | NS |
| Histamine 2 receptor blockers | 598 (16.1) | 85 (18.5) | 513 (15.8) | NS |
| Antibiotics | 2,931 (68.2) | 375 (72.8) | 2,556 (67.5) | 0.015 |
| Penicillins | 1,033 (24.0) | 115 (22.3) | 918 (24.3) | NS |
| Cephalosporins | 1,274 (29.6) | 179 (34.8) | 1,095 (28.9) | 0.007 |
| Tetracyclines | 191 (4.4) | 32 (6.2) | 159 (4.2) | 0.037 |
| Nitroimidazole | 614 (14.3) | 88 (17.1) | 526 (13.9) | 0.052 |
| Nitrofurantoin | 99 (2.3) | 21 (4.1) | 78 (2.1) | 0.004 |
| Immunotherapeutic agents | 1,707 (39.7) | 190 (36.9) | 1,517 (40.1) | NS |
| Steroids | 811 (18.9) | 101 (19.6) | 710 (18.8) | NS |
| Chemotherapy |
334 (7.8) |
49 (9.5) |
285 (7.5) |
NS |
| Clinical exposures prior to incident CDI | ||||
| Admitted | 2,194 (51.1) | 264 (51.4) | 1,930 (51.0) | NS |
| CDI as reason for admission | 1,098 (50.1) | 143 (54.4) | 955 (49.5) | NS |
| Emergency department visit | 1,579 (37.7) | 216 (43.5) | 1,363 (36.9) | 0.005 |
| Dialysis | 191 (4.6) | 29 (5.8) | 162 (4.4) | NS |
| Surgery | 561 (13.4) | 77 (15.5) | 484 (13.1) | NS |
| Death |
163 (3.8) |
1 (0.2) |
162 (4.3) |
<0.001 |
| Treatment of incident CDI | ||||
| Total no. cases during 2018–2020 | 2,121 | 246 | 1,875 | |
| Received treatment | 1,890 (89.1) | 218 (88.6) | 1,672 (89.2) | NS |
| Vancomycin | 1,344 (63.4) | 162 (65.9) | 1,182 (63.0) | NS |
| Metronidazole | 479 (22.6) | 47 (19.1) | 432 (23.0) | NS |
| Fidaxomicin | 28 (1.3) | 3 (1.2) | 25 (1.3) | NS |
| Other antibiotic | 7 (0.3) | 1 (0.4) | 6 (0.3) | NS |
| Stool transplant | 9 (0.4) | 1 (0.4) | 8 (0.4) | NS |
| Probiotics | 383 (18.1) | 40 (16.2) | 343 (18.3) | NS |
| >1 treatment course duration | 458 (21.6) | 55 (22.4) | 403 (21.5) | NS |
*Values are no. (%) except as indicated. CA, community-associated; CDI, Clostridioides difficile infection; CO-HCFA, community-onset healthcare facility–associated; HCFO, healthcare facility–onset; NS, not significant.
Page created: February 14, 2023
Page updated: April 13, 2023
Page reviewed: April 13, 2023
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