Risk factors for Clostridioides difficile infection in hospitalized patients and associated mortality in Japan: a multi-centre prospective cohort study - 02/03/20

Doi : 10.1016/j.jhin.2019.09.012

H. Honda ^a,^⁎ , H. Kato ^b, M.A. Olsen ^c, K.A. Reske ^c, M. Senoh ^b, T. Fukuda ^b, Y. Tagashira ^a, C. Mahe ^d, E.R. Dubberke ^c
the
Clostridioides difficile infection Japan study group^{^†}
The Clostridioides difficile infection Japan study group: H. Horiuchi, H. Chiba (Hachinohe City Hospital, Aomori, Japan); D. Suzuki, N. Hosokawa (Kameda Medical Center, Chiba, Japan); H. Kitazono, Y. Norisue, H. Kume (Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan); N. Mori, H. Morikawa, S. Kashiwagura, A. Higuchi (National Hospital Organization Tokyo Medical Center, Tokyo, Japan); H. Kato, M. Nakamura, S. Ishiguro, S. Morita (Toyokawa City Hospital, Aichi, Japan); H. Ishikawa, T. Watanabe, K. Kojima, I. Yokomaku, T. Bando (Tokai Central Hospital, Gifu, Japan); K. Toimoto, K. Moriya, K. Kasahara (Nara Medical University, Nara, Japan); S. Kitada, J. Ogawa, H. Saito (National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan); H. Tominaga, Y. Shimizu, F. Masumoto, K. Tadera (National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan); J. Yoshida, T. Kikuchi (Shimonoseki City Hospital, Yamaguchi, Japan); I. Yoshikawa, T. Watanabe, M. Honda, K. Yokote (University Hospital, University of Occupational and Environmental Health, Fukuoka, Japan); T. Toyokawa, H. Miyazato, M. Nakama (Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan).
H. Horiuchi, H. Chiba, D. Suzuki, N. Hosokawa, H. Kitazono, Y. Norisue, H. Kume, N. Mori, H. Morikawa, S. Kashiwagura, A. Higuchi, H. Kato, M. Nakamura, S. Ishiguro, S. Morita, H. Ishikawa, T. Watanabe, K. Kojima, I. Yokomaku, T. Bando, K. Toimoto, K. Moriya, K. Kasahara, S. Kitada, J. Ogawa, H. Saito, H. Tominaga, Y. Shimizu, F. Masumoto, K. Tadera, J. Yoshida, T. Kikuchi, I. Yoshikawa, T. Watanabe, M. Honda, K. Yokote, T. Toyokawa, H. Miyazato, M. Nakama

^a Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
^b Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
^c Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
^d Sanofi Pasteur, Lyon, France

^∗Corresponding author. Address: Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Tel.: +81 42 323 5111; fax: +81 42 312 9197.Division of Infectious DiseasesTokyo Metropolitan Tama Medical Center2-8-29 MusashidaiFuchuTokyo183-8524Japan

Summary

Background

Although population characteristics and antimicrobial prescribing practices suggest that the hospitalized population in Japan is at high risk of Clostridioides difficile infection (CDI), the epidemiology of CDI in Japan is poorly understood.

Aim

This prospective cohort study aimed to investigate the epidemiology of CDI at 12 hospitals in Japan.

Methods

Patients with clinically significant diarrhoea (CSD) were enrolled. Stool specimens were tested for C. difficile by toxin A and/or B enzyme immunoassay (EIA) in the hospital laboratories, and a toxigenic culture and nucleic acid amplification tests were performed at a central laboratory. The risk factors of CDI and the impact of CDI on mortality were investigated.

Findings

In total, 566 patients with CSD were included in the analyses. A total of 152 patients received the diagnosis of CDI by Toxin A/B EIA, toxigenic culture, or nucleic acid amplification test. Factors associated with CDI included low albumin (adjusted odds ratio (aOR): 1.56; 95% confidence interval (CI): 1.03–2.34) and length of hospital stay before stool collection >18 days (aOR: 1.73; 95% CI: 1.09–2.75). CDI was associated with an increased mortality on univariate analysis (OR: 1.6, 95% CI: 1.0–2.6) but was not associated with an increased risk of mortality on multivariable analysis.

Conclusion

Risk factors for CDI in Japan were similar to those identified in the USA and Europe. However, CDI was not associated with an increased risk of mortality in this population of patients with CSD.

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Keywords : Clostridioides difficile infection, Elderly population, Japan

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Case definition of Clostridioides difficile infection

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Vol 104 - N° 3

P. 350-357 - mars 2020 Retour au numéro

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Risk factors for Clostridioides difficile infection in hospitalized patients and associated mortality in Japan: a multi-centre prospective cohort study - 02/03/20

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