Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia

James D. Chalmers (Lead / Corresponding author), Ahsan R. Akram, Aran Singanayagam, Mark H. Wilcox, Adam T. Hill

Research output: Contribution to journalArticlepeer-review

54 Citations (Scopus)
251 Downloads (Pure)


ObjectivesClostridium difficile infection (CDI) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (CAP) is the leading indication for anti-biotic prescription in hospitals. This study assessed the incidence of and risk factors for CDI in a cohort of patients hospitalized with CAP. 

Methods: We analysed data from a prospective, observational cohort of patients with CAP in Edinburgh, UK. Patients with diarrhoea were systematically screened for CDI, and risk factors were determined through time-dependent survival analysis. 

Results: Overall, 1883 patients with CAP were included, 365 developed diarrhoea and 61 had laboratory-confirmed CDI. The risk factors for CDI were: age (hazard ratio [HR], 1.06 per year; 95% confidence interval [CI], 1.03-1.08), total number of antibiotic classes received (HR, 3.01 per class; 95% CI, 2.32-3.91), duration of antibiotic therapy (HR, 1.09 per day; 95% CI, 1.00-1.19 and hospitalization status (HR, 13.1; 95% CI, 6.0-28.7). Antibiotic class was not an independent predictor of CDI when adjusted for these risk factors (P > 0.05 by interaction testing).

Conclusions: These data suggest that reducing the overall antibiotic burden, duration of antibiotic treatment and duration of hospital stay may reduce the incidence of CDI in patients with CAP.

Original languageEnglish
Pages (from-to)45-53
Number of pages9
JournalJournal of Infection
Issue number1
Early online date19 Apr 2016
Publication statusPublished - Jul 2016


  • Antibiotics
  • Clostridium difficile
  • Healthcare-associated infections
  • Macrolides
  • Pneumonia

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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