Volume 29, Number 5—May 2023
CME ACTIVITY - Synopsis
Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015–2020
Table 4
Factors associated with recurrent CDI identified in 3 models, New Haven County, Connecticut, USA, 2015–2020*
| Factor | OR (95% CI) |
||
|---|---|---|---|
| Model 1* | Model 2† | Model 3‡ | |
| Year of recurrent CDI | |||
| 2016 | 0.73 (0.54–1.00)† | 0.68 (0.44–1.05) | 0.68 (0.44–1.06) |
| 2017 | 0.59 (0.42–0.83)† | 0.43 (0.26–0.72)‡ | 0.43 (0.26–0.73)§ |
| 2018 | 0.69 (0.50–0.96)† | 0.59 (0.37–0.95)‡ | 0.60 (0.37–0.97)§ |
| 2019 | 0.69 (0.49–0.97)† | 0.50 (0.30–0.84)‡ | 0.50 (0.30–0.84)§ |
| 2020 |
0.98 (0.72–1.32) |
0.72 (0.46–1.12) |
0.73 (0.46–1.16) |
| Age |
1.02 (1.01–1.02)† |
1.01 (1.00–1.02) |
1.01 (1.00–1.02) |
| Female sex |
1.20 (0.98–1.46) |
1.22 (0.92–1.63) |
1.22 (0.92–1.63) |
| Race or ethnicity | |||
| Black | 0.61(0.42–0.89)† | 0.50 (0.31–0.83)‡ | 0.50 (0.30–0.83)§ |
| Asian/American Indian/Pacific Islander | 0.27 (0.04–1.98) | <0.01 (<0.01 to >999.99) | <0.01 (<0.01 to >999.99) |
| Mixed/Unknown race |
0.97 (0.54–1.75) |
1.36 (0.58–3.20) |
1.36 (0.58–3.19) |
| Hispanic |
0.90 (0.51–1.58) |
0.64 (0.28–1.50) |
0.65 (0.28–1.51) |
| Medication history | |||
| Proton pump inhibitors | 0.85 (0.64–1.13) | 0.85 (0.64–1.13) | |
| Histamine 2 receptor blockers | 0.98 (0.68–1.41) | 0.97 (0.67–1.39) | |
| Antibiotics | 1.21 (0.80–1.81) | 1.21 (0.81–1.81) | |
| Penicillins | 1.03 (0.74–1.44) | 1.02 (0.73–1.42) | |
| Cephalosporins | 1.13 (0.81–1.57) | 1.10 (0.79–1.54) | |
| Tetracyclines | 1.05 (0.60–1.85) | 1.05 (0.60–1.85) | |
| Nitroimidazole | 0.93 (0.64–1.35) | 0.93 (0.65–1.34) | |
| Nitrofurantoin | 2.38 (1.23–4.59)‡ | 2.37 (1.23–4.58)§ | |
| Immunotherapeutic agents |
0.86 (0.62–1.18) |
0.85 (0.62–1.17) |
|
| Clinical history | |||
| Previous CDI | 1.03 (0.74–1.44) | 1.03 (0.74–1.44) | |
| Immunocompromised | 1.20 (0.89–1.61) | 1.19 (0.88–1.60) | |
| Cerebrovascular accident | 0.91 (0.58–1.43) | 0.90 (0.57–1.41) | |
| Cognitive Impairment or dementia | 0.91 (0.58–1.42) | 0.91 (0.58–1.42) | |
| Malignancy |
1.52 (1.11–2.08)‡ |
1.51 (1.11–2.07)§ |
|
| Clinical exposures | |||
| CDI as reason for admission | 1.48 (1.10–2.01)‡ | 1.46 (1.07–12.01)§ | |
| Emergency department visit | 1.32 (1.00–1.76) | 1.28 (0.95–1.71) | |
| Dialysis | 1.45 (0.85–2.47) | 1.44 (0.85–2.46) | |
| Surgery |
1.14 (0.80–1.64) |
1.11 (0.77–1.59) |
|
| Epidemiologic class | |||
| CO-HCFA | 1.10 (0.74–1.63) | ||
| CA | 0.93 (0.61–1.42) | ||
*Model 1 contains year of incident CDI diagnosis, age, sex, race, and ethnicity. Model 2 contains, in addition to model 1 variables, use of proton pump inhibitors, histamine 2 receptor blocker, antibiotics, penicillin, cephalosporin, tetracycline, nitroimidazole, nitroimidazoles, nitrofurans, immunotherapeutic agents, previous CDI, immunocompromised states, cerebrovascular accident, cognitive impairment or dementia, malignancy, admission because of CDI, emergency department visit, dialysis, and surgery. Model 3 contains, in addition to variables in model 2, the epidemiologic class of cases. CA, community-associated; CDI, Clostridioides difficile infection; CO-HCFA, community-onset healthcare facility–associated; OR, odds ratio. †Statistically significant in the first model. ‡Statistically significant in the second model. §Statistically significant in the final model.