ATLANTA – People who take antacid therapy, the elderly, and individuals who reside in long-term care facilities are at increased risk of recurrent Clostridium difficile infections, according to data from the Connecticut Emerging Infections Program.
Of 826 children and adults with an initial incident episode of C. difficile infection, 130 (16%) had at least one recurrence. Those with vs. without recurrence were significantly older (75.1 vs. 69.9 years), and significantly more likely to reside in a long-term care facility (53% vs. 40%), Blanca Paccha reported in a poster at the International Conference on Emerging Infectious Diseases.
Individuals with recurrence were more likely than those without recurrence to be taking H2 blockers (10% vs. 3%), reported Ms. Paccha, a research assistant and student working on her master’s in Public Health at Yale University, New Haven, Conn.
When stratified based on whether the C. difficile infection was acquired in the health care setting or in the community, the only difference between the recurrence and nonrecurrence groups in those with health care–associated infection was the use of H2 blockers, which appeared to increase the risk for recurrence in this population. This finding contradicts those from previous studies that suggested a protective effect of antacid therapy, Ms. Paccha noted.
In those with community-associated infection, those with recurrence were older than those without recurrence (68.9 vs. 56.6 years). They also were significantly more likely to have used immunosuppressants (36% vs. 13%), and less likely to have used antimicrobials (73% vs. 43%), Ms. Paccha said in an interview.
C. difficile, which is often preceded by antibiotic use, has been a growing concern in the past decade because of the emergence of increasingly toxigenic strains. The Connecticut Emerging Infections Program has been conducting surveillance for the infection since 2009, she said.
Case patients were at least 1 year of age and were diagnosed on the basis of a positive C. difficile infection laboratory test. Those with health care–associated infection included patients with onset 3 days after hospital or long-term care facility admission (health care facility onset patients); patients with onset within 3 months of hospital discharge, outpatient surgery or long-term care facility residency (community-onset health care facility-associated patients); and patients with onset without prior health care exposure (community-associated infection patients). Information on the patients was obtained by chart review.
The study was limited by the use of a nonclinical definition of recurrence and by a lack of treatment data for the initial C. difficile infection.
Additional research to determine if those at risk for recurrence tend to harbor more toxigenic diseases is warranted, she said.
Ms. Paccha reported having no relevant conflicts of interest.