Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder

Am J Infect Control. 2014 Feb;42(2):168-73. doi: 10.1016/j.ajic.2013.08.009.

Abstract

Background: Recurrent Clostridium difficile (CDI) infection is a growing concern; however, there are little data on impact of recurrent CDI on those with spinal cord injury and disorder (SCI/D). Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D.

Methods: This was a retrospective cohort study with data from outpatient, inpatient, and extended care settings at 83 Department of Veterans Affairs facilities from 2002 to 2009.

Results: Of 1,464 cases of CDI analyzed, 315 cases (21.5%) had a first recurrence of CDI. Multivariable regression demonstrated that risk factors significantly associated with increased recurrence were concomitant fluoroquinolone use (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08-1.80), whereas concomitant tetracycline use (OR, 0.35; 95% CI: 0.14-0.90), and cerebrovascular accident (OR, 0.46; 95% CI: 0.25-0.85) were associated with decreased recurrence. A subanalysis in those with health care facility-onset CDI showed that increased length of stay postinitial CDI was a significant risk factor for recurrence as was concomitant use of fluoroquinolones and that tetracycline remained protective for recurrence.

Conclusion: Concomitant fluoroquinolone use was a risk factor for the recurrence of CDI. In contrast, tetracyclines and cerebrovascular accident were protective. Length of stay greater than 90 days from the initial CDI episode was also a risk factor for recurrence among those with health care facility-onset CDI. Future studies should focus on effective strategies to prevent these risk factors among the SCI/D population.

Keywords: C difficile infection; Concomitant antibiotics; First recurrence; Length of stay; Veterans Affairs.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Clostridioides difficile / isolation & purification*
  • Clostridium Infections / chemically induced
  • Clostridium Infections / epidemiology*
  • Clostridium Infections / microbiology
  • Cohort Studies
  • Diarrhea / chemically induced
  • Diarrhea / epidemiology*
  • Diarrhea / microbiology
  • Female
  • Fluoroquinolones / therapeutic use
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Spinal Cord Diseases / complications*
  • Spinal Cord Injuries / complications*
  • Veterans
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Fluoroquinolones