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Medication Exposure and Risk of Recurrent Clostridium difficile Infection in Community‐Dwelling Older People and Nursing Home Residents
Author(s) -
Haran John P.,
Bradley Evan,
Howe Emily,
Wu Xun,
Tjia Jennifer
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15176
Subject(s) - medicine , clostridium difficile , hazard ratio , confidence interval , retrospective cohort study , gerontology , antibiotics , microbiology and biotechnology , biology
Background/Objectives It is unclear how medication exposures differ in their association with recurrent Clostridium difficile infection ( rCDI ) in elderly nursing home ( NH ) residents and community‐dwelling individuals. This study examined these exposures to determine whether the risk of rCDI differs according to living environment. Design Retrospective. Setting Academic and community healthcare settings. Participants Individuals aged 65 and older with CDI (N = 616). Measurements Information on participant characteristics and medications was extracted from the electronic medical record ( EMR ). We used separate extended Cox models according to living environment to identify the association between medication use and risk of rCDI . Results Of the 616 elderly adults treated for CDI , 24.1% of those living in the community and 28.1% of NH residents experienced recurrence within 1 year. For community‐dwelling participants, the risk of rCDI was 1.6 times as high with antibiotic exposure and 2.5 times as high with acid‐reducing medication exposure, but corticosteroid exposure was associated with a 39% lower risk of recurrence. For NH residents, the risk of rCDI was 2.9 times as high with acid‐reducing medication exposure and 5.9 times as high with corticosteroid medication exposure. Antibiotic exposure was associated with an increased risk of recurrence only in community‐dwelling participants (adjusted hazard ratio = 1.63, 95% confidence interval = 1.00–2.67). Conclusion Risk of rCDI is greater with acid‐reducing medication use than antibiotic use after initial CDI treatment, although the risk varied depending on living environment. Corticosteroid use is associated with greater risk of recurrence in NH residents but lower risk in community‐dwelling elderly adults.