Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset
Recurrent Clostridioides (Clostridium) difficile infection (rCDI) is common and increases healthcare resource utilization. In this study, we assessed rCDI risk factors using an up-to-date, Japanese national hospital-based database. C. difficile infection (CDI) episodes, occurring July 2014–June 2017...
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| Veröffentlicht in: | Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2019-08, Vol.25 (8), p.615-620 |
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| creator | Kimura, Tomomi Snijder, Robert Sugitani, Toshifumi |
| description | Recurrent Clostridioides (Clostridium) difficile infection (rCDI) is common and increases healthcare resource utilization. In this study, we assessed rCDI risk factors using an up-to-date, Japanese national hospital-based database.
C. difficile infection (CDI) episodes, occurring July 2014–June 2017, in patients aged ≥18 years were extracted from the database and a nested case-control analysis was performed. Cases were defined as rCDI episodes which required re-initiation of oral vancomycin or oral/intravenous metronidazole treatment within 8 weeks from the start of initial treatment. Cases were matched to 4 non-rCDI episodes at the timing of rCDI occurrence. Adjusted odds ratios (ORs) were estimated using multivariate conditional logistic regression model.
Of 18,246 initial CDI episodes, 3250 (17.8%) had at least one rCDI. Approximately 90% of episodes occurred in inpatients and 65% were treated with metronidazole. Older age ( |
| doi_str_mv | 10.1016/j.jiac.2019.03.011 |
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C. difficile infection (CDI) episodes, occurring July 2014–June 2017, in patients aged ≥18 years were extracted from the database and a nested case-control analysis was performed. Cases were defined as rCDI episodes which required re-initiation of oral vancomycin or oral/intravenous metronidazole treatment within 8 weeks from the start of initial treatment. Cases were matched to 4 non-rCDI episodes at the timing of rCDI occurrence. Adjusted odds ratios (ORs) were estimated using multivariate conditional logistic regression model.
Of 18,246 initial CDI episodes, 3250 (17.8%) had at least one rCDI. Approximately 90% of episodes occurred in inpatients and 65% were treated with metronidazole. Older age (<75 years vs 75–84 years and vs 85 + years) was associated with higher risk of rCDI (OR = 1.27, 95% confidence interval [1.15, 1.41] and 1.45 [1.30, 1.61], respectively). Use of systemic antibiotics (3.16 [2.90, 3.44]), probiotics (2.53 [2.32, 2.77]), chemotherapy (1.28 [1.08, 1.53]), or proton pump inhibitors (PPIs) (1.17 [1.07, 1.28]), and prior CDI history (1.22 [1.03, 1.43]) were also identified as rCDI risk factors. Vancomycin reduced the risk of rCDI compared with metronidazole treatment (0.83 [0.76, 0.91]).
This large, multicenter, nationwide study confirmed that older age, PPIs, antibiotics, probiotics, chemotherapy, and prior CDI history are risk factors for rCDI in Japan. There was a 17% decrease of rCDI risk with vancomycin vs metronidazole treatment.
Clinical trial registration number: N/A.</description><identifier>ISSN: 1341-321X</identifier><identifier>EISSN: 1437-7780</identifier><identifier>DOI: 10.1016/j.jiac.2019.03.011</identifier><identifier>PMID: 30987950</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Case-Control Studies ; Clostridioides (Clostridium) difficile infection ; Clostridium difficile - drug effects ; Clostridium Infections - drug therapy ; Cross Infection - drug therapy ; Cross Infection - microbiology ; Female ; Hospitals ; Humans ; Inpatients ; Japan ; Logistic Models ; Male ; Metronidazole - therapeutic use ; Proton Pump Inhibitors - therapeutic use ; Recurrence ; Retrospective Studies ; Risk Factors ; Vancomycin - therapeutic use</subject><ispartof>Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 2019-08, Vol.25 (8), p.615-620</ispartof><rights>2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases</rights><rights>Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-1403572f7a664818c14593419c131748a0d47b04940cff50f1d2266049841033</citedby><cites>FETCH-LOGICAL-c424t-1403572f7a664818c14593419c131748a0d47b04940cff50f1d2266049841033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30987950$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kimura, Tomomi</creatorcontrib><creatorcontrib>Snijder, Robert</creatorcontrib><creatorcontrib>Sugitani, Toshifumi</creatorcontrib><title>Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset</title><title>Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</title><addtitle>J Infect Chemother</addtitle><description>Recurrent Clostridioides (Clostridium) difficile infection (rCDI) is common and increases healthcare resource utilization. In this study, we assessed rCDI risk factors using an up-to-date, Japanese national hospital-based database.
C. difficile infection (CDI) episodes, occurring July 2014–June 2017, in patients aged ≥18 years were extracted from the database and a nested case-control analysis was performed. Cases were defined as rCDI episodes which required re-initiation of oral vancomycin or oral/intravenous metronidazole treatment within 8 weeks from the start of initial treatment. Cases were matched to 4 non-rCDI episodes at the timing of rCDI occurrence. Adjusted odds ratios (ORs) were estimated using multivariate conditional logistic regression model.
Of 18,246 initial CDI episodes, 3250 (17.8%) had at least one rCDI. Approximately 90% of episodes occurred in inpatients and 65% were treated with metronidazole. Older age (<75 years vs 75–84 years and vs 85 + years) was associated with higher risk of rCDI (OR = 1.27, 95% confidence interval [1.15, 1.41] and 1.45 [1.30, 1.61], respectively). Use of systemic antibiotics (3.16 [2.90, 3.44]), probiotics (2.53 [2.32, 2.77]), chemotherapy (1.28 [1.08, 1.53]), or proton pump inhibitors (PPIs) (1.17 [1.07, 1.28]), and prior CDI history (1.22 [1.03, 1.43]) were also identified as rCDI risk factors. Vancomycin reduced the risk of rCDI compared with metronidazole treatment (0.83 [0.76, 0.91]).
This large, multicenter, nationwide study confirmed that older age, PPIs, antibiotics, probiotics, chemotherapy, and prior CDI history are risk factors for rCDI in Japan. There was a 17% decrease of rCDI risk with vancomycin vs metronidazole treatment.
Clinical trial registration number: N/A.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Case-Control Studies</subject><subject>Clostridioides (Clostridium) difficile infection</subject><subject>Clostridium difficile - drug effects</subject><subject>Clostridium Infections - drug therapy</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - microbiology</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Japan</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Metronidazole - therapeutic use</subject><subject>Proton Pump Inhibitors - therapeutic use</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Vancomycin - therapeutic use</subject><issn>1341-321X</issn><issn>1437-7780</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhSMEoqXwAiyQl2WRcP2TxEFsqhFQqkrddNGd5fFPe4fEHuykVft6vBieTumyK9tH556j66-qPlJoKNDuy6bZoDYNAzo0wBug9FV1SAXv676X8LrcuaA1Z_TqoHqX8waA9q2Ub6sDDoPshxYOq7-rG520mV3CBz1jDEQHSxLm38QXOaZMfEwkObOk5IJxJHqyGmOeE1qMaF0mx8_vZfpMLHqPBkdHMHhnHjMxkDO91eErOSHhseauTJZUPdZ3MY22tOrxPmMmS8ZwTTQZdbp25CbmLc7FtdbZFZedMGDpKhm3jlg9F3l-X73xeszuw9N5VF3--H65Oq3PL37-Wp2c10YwMddUAG975nvddUJSaahoh_JDg6Gc9kJqsKJfgxgEGO9b8NQy1nVFkIIC50fV8T52m-KfxeVZTZiNG0cdXFyyYowC45JJVqxsbzUp5pycV9uEk073ioLasVMbtWOnduwUcFXYlaFPT_nLenL2eeQ_rGL4tje4suQtuqSywR0Ti4XPrGzEl_L_AaaXrbY</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Kimura, Tomomi</creator><creator>Snijder, Robert</creator><creator>Sugitani, Toshifumi</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201908</creationdate><title>Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset</title><author>Kimura, Tomomi ; Snijder, Robert ; Sugitani, Toshifumi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-1403572f7a664818c14593419c131748a0d47b04940cff50f1d2266049841033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Case-Control Studies</topic><topic>Clostridioides (Clostridium) difficile infection</topic><topic>Clostridium difficile - drug effects</topic><topic>Clostridium Infections - drug therapy</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - microbiology</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Japan</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Metronidazole - therapeutic use</topic><topic>Proton Pump Inhibitors - therapeutic use</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Vancomycin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kimura, Tomomi</creatorcontrib><creatorcontrib>Snijder, Robert</creatorcontrib><creatorcontrib>Sugitani, Toshifumi</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kimura, Tomomi</au><au>Snijder, Robert</au><au>Sugitani, Toshifumi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset</atitle><jtitle>Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</jtitle><addtitle>J Infect Chemother</addtitle><date>2019-08</date><risdate>2019</risdate><volume>25</volume><issue>8</issue><spage>615</spage><epage>620</epage><pages>615-620</pages><issn>1341-321X</issn><eissn>1437-7780</eissn><abstract>Recurrent Clostridioides (Clostridium) difficile infection (rCDI) is common and increases healthcare resource utilization. In this study, we assessed rCDI risk factors using an up-to-date, Japanese national hospital-based database.
C. difficile infection (CDI) episodes, occurring July 2014–June 2017, in patients aged ≥18 years were extracted from the database and a nested case-control analysis was performed. Cases were defined as rCDI episodes which required re-initiation of oral vancomycin or oral/intravenous metronidazole treatment within 8 weeks from the start of initial treatment. Cases were matched to 4 non-rCDI episodes at the timing of rCDI occurrence. Adjusted odds ratios (ORs) were estimated using multivariate conditional logistic regression model.
Of 18,246 initial CDI episodes, 3250 (17.8%) had at least one rCDI. Approximately 90% of episodes occurred in inpatients and 65% were treated with metronidazole. Older age (<75 years vs 75–84 years and vs 85 + years) was associated with higher risk of rCDI (OR = 1.27, 95% confidence interval [1.15, 1.41] and 1.45 [1.30, 1.61], respectively). Use of systemic antibiotics (3.16 [2.90, 3.44]), probiotics (2.53 [2.32, 2.77]), chemotherapy (1.28 [1.08, 1.53]), or proton pump inhibitors (PPIs) (1.17 [1.07, 1.28]), and prior CDI history (1.22 [1.03, 1.43]) were also identified as rCDI risk factors. Vancomycin reduced the risk of rCDI compared with metronidazole treatment (0.83 [0.76, 0.91]).
This large, multicenter, nationwide study confirmed that older age, PPIs, antibiotics, probiotics, chemotherapy, and prior CDI history are risk factors for rCDI in Japan. There was a 17% decrease of rCDI risk with vancomycin vs metronidazole treatment.
Clinical trial registration number: N/A.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>30987950</pmid><doi>10.1016/j.jiac.2019.03.011</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Case-Control Studies Clostridioides (Clostridium) difficile infection Clostridium difficile - drug effects Clostridium Infections - drug therapy Cross Infection - drug therapy Cross Infection - microbiology Female Hospitals Humans Inpatients Japan Logistic Models Male Metronidazole - therapeutic use Proton Pump Inhibitors - therapeutic use Recurrence Retrospective Studies Risk Factors Vancomycin - therapeutic use |
| title | Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset |
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