AUTHOR=Lang Vanessa , Gunka Katrin , Ortlepp Jan Rudolf , Zimmermann Ortrud , Groß Uwe 

TITLE=Risk Factors of Patients With Diarrhea for Having Clostridioides (Clostridium) difficile Infection

JOURNAL=Frontiers in Microbiology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.840846

DOI=10.3389/fmicb.2022.840846

ISSN=1664-302X

ABSTRACT=<p>Nosocomial infections with <italic>Clostridioides (Clostridium) difficile</italic> have become an emergent health threat. We sought to define risk factors for a <italic>C. difficile</italic> infection (CDI) beyond the widely known ones, such as antibiotic use and prior hospital stay. We therefore focused on a group of patients with diarrhea in order to identify risk factors for <italic>C. difficile</italic> infection among this symptomatic cohort. A total of 121 hospitalized patients from Seesen/Germany with diarrhea were included who submitted a stool sample and were interviewed about their socio-demographic background, lifestyle and state of health using a standardized questionnaire. Antibiotic potential of diuretics was examined by agar diffusion test. <italic>C. difficile</italic> was identified in 29 patients resulting in a prevalence of 24.0%. The infection was hospital-acquired in most cases (<italic>p</italic> &lt; 0.001, 82.1%; <italic>n</italic> = 23/28, versus 29/91, 31.9%). The generally accepted risk factor previous antibiotic use was confirmed in this study (<italic>p</italic> = 0.002, <italic>n</italic> = 23/28 CDI patients, 82.1%, versus <italic>n</italic> = 44/91 non-CDI patients, 48.4%). The following additional risk factors were identified: regular consumption of proton pump inhibitors; PPI (<italic>p</italic> = 0.011, <italic>n</italic> = 24/29, 82.8% vs. <italic>n</italic> = 52/92, 56.5%), CDI patients ate less vegetables (<italic>p</italic> = 0.001, <italic>n</italic> = 12/29, 41.4% vs. 69/92, 75.0%). The intake of the diuretic agent torasemid in patients with CDI (<italic>p</italic> = 0.005, <italic>n</italic> = 18/29, 62.1%) was higher than in patients without (<italic>n</italic> = 30/92, 32.6%). More patients with CDI had to undergo a surgery in the previous year (<italic>p</italic> = 0.022, <italic>n</italic> = 13/29, 44.8% vs. <italic>n</italic> = 21/92, 22.8%) and held more birds (<italic>p</italic> = 0.056, <italic>n</italic> = 4/29, 13.8%) than individuals of the negative group (<italic>n</italic> = 3/92, 3.3%). In conclusion, although no antibiotic potential was detected in diuretics, especially torasemid seems to have significant influence for the occurrence of a CDI as well as a nutrition poor in vegetables. A diet rich in vegetables represented a fourfold lower risk for a CDI (OR 0.240, CI (0.0720 - 0.796]).</p>