Predictors of Clostridium difficile infection and predictive impact of probiotic use in a diverse hospital-wide cohort

•Clostridium difficile infection (CDI) was most frequently diagnosed in the emergency department.•Exposures to high-risk antibiotics, statins, and probiotics were predictive of CDI.•Probiotics did not appear to attenuate the odds of CDI in patients on antibiotics.•Some antibiotics appeared to attenuate the odds of CDI in patients on probiotics.•Bacterial probiotics were associated with higher odds of CDI than fungal probiotics. Hospital-based predictive models for Clostridium difficile infection (CDI) may aid with surveillance efforts. A retrospective cohort of adult hospitalized patients who were tested for CDI between May 1, 2011, and August 31, 2016, was formed. Proposed clinical and sociodemographic predictors of CDI were evaluated using multivariable predictive logistic regression modeling. In a cohort of 5,209 patients, including 1,092 CDI cases, emergency department location (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.51, 2.41; compared with an intensive care unit reference category, which had the lowest observed odds in the study) and prior exposure to a statin (aOR, 1.26, 95% CI, 1.06, 1.51), probiotic (aOR, 1.39; 95% CI, 1.08, 1.80), or high-risk antibiotic (aOR, 1.54; 95% CI, 1.29, 1.84), such as a cephalosporin, a quinolone, or clindamycin, were independent predictors of CDI. Probiotic use did not appear to attenuate the odds of CDI in patients exposed to high-risk antibiotics, but moderate-risk antibiotics appeared to significantly attenuate the odds of CDI in patients who received probiotics. Emergency department location, high-risk antibiotics, probiotics, and statins were independently predictive of CDI. Further exploration of the relationship between probiotics and CDI, especially in diverse patient populations, is warranted.