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Factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI) in a Mexican tertiary care hospital: A case-control study.
PloS One 2018
OBJECTIVE: To identify clinical and environmental factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI).
DESIGN: Case-control study.
SETTING: Public, acute care, academic tertiary referral center in Mexico.
PATIENTS: Adults hospitalized ≥48 hours between January 2015 and December 2016 were included. Cases were patients with a first episode of HO-HCFA CDI. Controls were patients with any other diagnosis; they were randomly selected from the hospital discharge database and matched in a 1:2 manner according to the date of diagnosis of case ± 10 days. Variables with p<0.1 were considered for multivariable analysis.
RESULTS: One hundred and fifty-five cases and 310 controls were included. Variables independently associated with HO-HCFA CDI were: exposure to both ciprofloxacin and proton pump inhibitor (PPI) within the last 3 months (OR = 8.07, 95% CI = 1.70-38.16), febrile neutropenia (OR = 4.61, 95% CI = 1.37-15.46), intraabdominal infection (OR = 2.06, 95% CI = 0.95-4.46), referral from other hospitals (OR = 1.99, 95% CI = 0.98-4.05) and an increasing number of antibiotics previously used (OR = 1.28, 95% CI = 1.13-1.46).
CONCLUSIONS: Multiple factors were found to be associated with the first episode of HO-HCFA CDI in the setting of an outbreak; of the modifiable risk factors, prior exposure to both ciprofloxacin and PPI was the most important. Referral from other hospitals was an environmental risk factor that deserves further study.
DESIGN: Case-control study.
SETTING: Public, acute care, academic tertiary referral center in Mexico.
PATIENTS: Adults hospitalized ≥48 hours between January 2015 and December 2016 were included. Cases were patients with a first episode of HO-HCFA CDI. Controls were patients with any other diagnosis; they were randomly selected from the hospital discharge database and matched in a 1:2 manner according to the date of diagnosis of case ± 10 days. Variables with p<0.1 were considered for multivariable analysis.
RESULTS: One hundred and fifty-five cases and 310 controls were included. Variables independently associated with HO-HCFA CDI were: exposure to both ciprofloxacin and proton pump inhibitor (PPI) within the last 3 months (OR = 8.07, 95% CI = 1.70-38.16), febrile neutropenia (OR = 4.61, 95% CI = 1.37-15.46), intraabdominal infection (OR = 2.06, 95% CI = 0.95-4.46), referral from other hospitals (OR = 1.99, 95% CI = 0.98-4.05) and an increasing number of antibiotics previously used (OR = 1.28, 95% CI = 1.13-1.46).
CONCLUSIONS: Multiple factors were found to be associated with the first episode of HO-HCFA CDI in the setting of an outbreak; of the modifiable risk factors, prior exposure to both ciprofloxacin and PPI was the most important. Referral from other hospitals was an environmental risk factor that deserves further study.
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