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Risk factors for recurrent Clostridium difficile infection: a systematic review and meta-analysis.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / OBJECTIVE:
An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI.
DESIGN:
We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated.
RESULTS:
A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001).
CONCLUSIONS:
Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.

Identiferoai:union.ndltd.org:PERUUPC/oai:repositorioacademico.upc.edu.pe:10757/608263
Date04 1900
CreatorsDeshpande, Abhishek, Pasupuleti, Vinay, Thota, Priyaleela, Pant, Chaitanya, Rolston, David D K, Hernandez, Adrian V., Donskey, Curtis J, Fraser, Thomas G
PublisherCambridge University Press
Source SetsUniversidad Peruana de Ciencias Aplicadas (UPC)
LanguageEnglish
Detected LanguageEnglish
Typeinfo:eu-repo/semantics/article
SourceUniversidad Peruana de Ciencias Aplicadas (UPC), Repositorio Académico - UPC
Rightsinfo:eu-repo/semantics/openAccess
Relationhttp://www.ncbi.nlm.nih.gov/pubmed/25626326

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