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Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries

BACKGROUND: Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated infections in Western countries. Risk factors, mortality, and healthcare utilization for CDI in Latin America are poorly understood. This study assessed risk factors and burden associated with noso...

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Autores principales: Yu, Holly, Flaster, Nestor, Casanello, Adrian Lopez, Curcio, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392087/
https://www.ncbi.nlm.nih.gov/pubmed/33290727
http://dx.doi.org/10.1016/j.bjid.2020.11.005
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author Yu, Holly
Flaster, Nestor
Casanello, Adrian Lopez
Curcio, Daniel
author_facet Yu, Holly
Flaster, Nestor
Casanello, Adrian Lopez
Curcio, Daniel
author_sort Yu, Holly
collection PubMed
description BACKGROUND: Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated infections in Western countries. Risk factors, mortality, and healthcare utilization for CDI in Latin America are poorly understood. This study assessed risk factors and burden associated with nosocomial CDI in four Latin American countries. METHODS: This retrospective, case-control study used databases and medical records from 8 hospitals in Argentina, Brazil, Chile, and Mexico to identify nosocomial CDI cases from 2014 − 2017. Cases were patients aged ≥18 years with diarrhea and a positive CDI test ≥72 h after hospital admission. Two controls (without diarrhea; length of hospital stay [LOS] ≥3 days; admitted ±14 days from case patient; shared same ward) were matched to each case. CDI-associated risk factors were assessed by univariate and multivariable analyses. CDI burden (LOS, in-hospital mortality) was compared between cases and controls. RESULTS: The study included 481 cases and 962 controls. Mean age and sex were similar between cases and controls, but mean Charlson comorbidity index (4.3 vs 3.6; p < 0.001) and recent hospital admission (35.3% vs 18.8%; p < 0.001) were higher among cases. By multivariable analyses, CDI risk was associated with prior hospital admission within 3 months (odds ratio [OR], 2.08; 95% CI: 1.45, 2.97), recent antibiotic use (ie, carbapenem; OR, 2.85; 95% CI: 1.75, 4.64), acid suppressive therapy use (OR, 1.71; 95% CI: 1.14, 2.58), and medical conditions (ie, renal disease; OR, 1.48; 95% CI: 1.19, 1.85). In-hospital mortality rate (18.7% vs 6.9%; p < 0.001) and mean overall LOS (33.5 vs 18.8 days; p < 0.001) were higher and longer, respectively, in cases versus controls. CONCLUSION: Antibiotic exposure, preexisting medical conditions, and recent hospital admission were major risk factors for CDI in Argentina, Brazil, Chile, and Mexico. CDI was associated with increased in-hospital risk of death and longer LOS. These findings are consistent with published literature in Western countries.
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spelling pubmed-93920872022-08-23 Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries Yu, Holly Flaster, Nestor Casanello, Adrian Lopez Curcio, Daniel Braz J Infect Dis Original Article BACKGROUND: Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated infections in Western countries. Risk factors, mortality, and healthcare utilization for CDI in Latin America are poorly understood. This study assessed risk factors and burden associated with nosocomial CDI in four Latin American countries. METHODS: This retrospective, case-control study used databases and medical records from 8 hospitals in Argentina, Brazil, Chile, and Mexico to identify nosocomial CDI cases from 2014 − 2017. Cases were patients aged ≥18 years with diarrhea and a positive CDI test ≥72 h after hospital admission. Two controls (without diarrhea; length of hospital stay [LOS] ≥3 days; admitted ±14 days from case patient; shared same ward) were matched to each case. CDI-associated risk factors were assessed by univariate and multivariable analyses. CDI burden (LOS, in-hospital mortality) was compared between cases and controls. RESULTS: The study included 481 cases and 962 controls. Mean age and sex were similar between cases and controls, but mean Charlson comorbidity index (4.3 vs 3.6; p < 0.001) and recent hospital admission (35.3% vs 18.8%; p < 0.001) were higher among cases. By multivariable analyses, CDI risk was associated with prior hospital admission within 3 months (odds ratio [OR], 2.08; 95% CI: 1.45, 2.97), recent antibiotic use (ie, carbapenem; OR, 2.85; 95% CI: 1.75, 4.64), acid suppressive therapy use (OR, 1.71; 95% CI: 1.14, 2.58), and medical conditions (ie, renal disease; OR, 1.48; 95% CI: 1.19, 1.85). In-hospital mortality rate (18.7% vs 6.9%; p < 0.001) and mean overall LOS (33.5 vs 18.8 days; p < 0.001) were higher and longer, respectively, in cases versus controls. CONCLUSION: Antibiotic exposure, preexisting medical conditions, and recent hospital admission were major risk factors for CDI in Argentina, Brazil, Chile, and Mexico. CDI was associated with increased in-hospital risk of death and longer LOS. These findings are consistent with published literature in Western countries. Elsevier 2020-12-05 /pmc/articles/PMC9392087/ /pubmed/33290727 http://dx.doi.org/10.1016/j.bjid.2020.11.005 Text en © 2020 Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Infectologia. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Yu, Holly
Flaster, Nestor
Casanello, Adrian Lopez
Curcio, Daniel
Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
title Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
title_full Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
title_fullStr Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
title_full_unstemmed Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
title_short Assessing risk factors, mortality, and healthcare utilization associated with Clostridioides difficile infection in four Latin American countries
title_sort assessing risk factors, mortality, and healthcare utilization associated with clostridioides difficile infection in four latin american countries
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392087/
https://www.ncbi.nlm.nih.gov/pubmed/33290727
http://dx.doi.org/10.1016/j.bjid.2020.11.005
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