Background: Clostridioides difficile infection (CDI) is a healthcare-associated infection associated with significant morbidity and cost with highly variable risk across populations. More effective, risk-based prevention strategies are needed. Here we investigate risk factors for hospital-associated CDI in a large integrated health system.Methods: In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (1) hospital-onset and (2) healthcare-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including specific agents, using multivariable logistic regression.Results: 2356 cases of CDI among 506,068 admissions were identified (incidence 46.6 per 10,000). Prior antibiotic use was the dominant risk factor - for every antibiotic day of therapy prior to the index admission, odds of subsequent CDI increased by 12.8% (95% CI 12.2-13.4%, p<0.0001). This was a much stronger association than was inpatient antibiotic exposure (OR 1.007 (95% CI 1.005-1.009, p<0.0001). Highest risk antibiotics included 2nd generation and later cephalosporins (especially oral), carbapenems, fluroquinolones, and clindamycin, while doxycycline and daptomycin were associated with lower CDI risk.Conclusions: Cumulative antibiotic exposure prior to admission is the greatest contributor to risk of subsequent CDI. Most classes of antibiotics carry some risk, which varies by drug and route. This information may be useful for antimicrobial stewardship efforts.
View details for DOI 10.1128/AAC.02169-19
View details for PubMedID 31964789