Risk Factors for Development of Clostridium Difficile Infection Due to BI/NAP1/027 Strain: a Meta-analysis

Objective: To identify risk factors for the development of Clostridium difficile infection (CDI) due to C. difficile BI/NAP1/027 strain.

Methods: PubMed and Scopus databases were searched for studies that sought to identify risk factors for CDI due to the BI/NAP1/027 strain. The technique of meta-analysis was applied.

Results: Five studies compared CDI BI/NAP1/027 patients to CDI patients infected with non-BI/NAP1/027 strains, one compared CDI BI/NAP1/027 patients to non-CDI patients, and one provided data for both comparisons. The meta-analysis showed that fluoroquinolones were associated with a higher risk of CDI due to BI/NAP1/027 when compared to non-BI/NAP1/027 CDI (odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.37-2.80). A trend towards a lower risk for CDI due to BI/NAP1/027 was observed with cephalosporins when compared to non-BI/NAP1/027 CDI (OR 0.70, 95% CI 0.46-1.07). Prior macrolides were not associated with a higher risk for CDI BI/NAP1/027 when compared with non-BI/NAP1/027 CDI controls (OR 0.88, 95% CI 0.44-1.78). Clindamycin administration was associated with a lower risk for CDI due to BI/NAP1/027 when compared to non-BI/NAP1/027 CDI (OR 0.24, 95% CI 0.12-0.48). Age over 65 years was associated with an increased risk of CDI BI/NAP1/027 compared to non-BI/NAP1/027 CDI (OR 1.77, 95% CI 1.31-2.38).

Conclusions: Fluoroquinolones and age over 65 years were associated with a higher risk of CDI due to the BI/NAP1/027 strain. Clindamycin was associated with a lower risk of CDI due to BI/NAP1/027.