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

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Authors: Ramanathan, S; Johnson, S; Burns, S. P.; Kralovic, S. M.; Goldstein, B; Smith, B; Gerding, D. N.; Evans, C. T.
Article Title: Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder
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.
Journal Title: American Journal of Infection Control
Volume: 42
Issue: 2
ISSN: 1527-3296; 0196-6553
Publisher: Unknown  
Journal Place: United States
Date Published: 2014
Start Page: 168
End Page: 173
Language: eng
DOI/URL:

10.1016/j.ajic.2013.08.009

10.1016/j.ajic.2013.08.009
Notes: CI: Published by Mosby, Inc.; JID: 8004854; OTO: NOTNLM; 2013/06/21 [received]; 2013/08/13 [revised]; 2013/08/20 [accepted]; ppublish