# Clinical Characteristics and Risk Factors of Clostridioides difficile Infection: A Case–Control Study in a High-Complexity Clinic in Santiago de Cali, Colombia

## TL;DR

This study identifies risk factors for Clostridioides difficile infection in a hospital in Colombia, showing that prolonged hospital stays and antibiotic use are significant contributors.

## Contribution

The study provides new insights into CDI risk factors specific to a high-complexity clinic in Colombia.

## Key findings

- CDI prevalence was 22% among those tested, with 55% being healthcare-associated.
- Hospital stay longer than 10 days and antibiotic exposure were significant risk factors for CDI.
- Severe CDI cases had a 15% 30-day mortality rate.

## Abstract

Objectives: This study aimed to describe the epidemiological and clinical characteristics and the potential risk factors associated with Clostridioides difficile infection (CDI) in a high-complexity healthcare center. Methods: This was a retrospective case–control study conducted from 2020 to 2022 with a cohort of participants aged ≥18 years with diarrhea (more than three liquid stools per day), which included a molecular testing request (the FilmArray Gastrointestinal [GI] PCR Panel) in a high-complexity clinic in Santiago de Cali, Colombia. Controls were randomly selected from the same institutional laboratory database at a 2:1 ratio, matched by age and sex, and required to test negative for C. difficile. Patients from other institutions were excluded to avoid exposure misclassification. Results: Our study included 147 participants (49 cases and 98 controls) and found a 22% infection prevalence among those who underwent molecular testing. When comparing CDI cases with controls, significant differences were observed in the univariate analysis: cases showed longer time to symptom resolution, longer post-diagnosis hospital stay, and greater exposure to in-hospital antibiotics for more than 7 days prior to symptom onset (p < 0.05). Among CDI cases, 55% were healthcare-associated and 18% were classified as severe, with an overall 30-day mortality of 15%. In the multivariate logistic regression model, three variables remained significantly associated with CDI: hospital stay longer than 10 days before symptom onset, antibiotic exposure in the previous 90 days, and in-hospital proton pump inhibitor use. Conclusions: CDI can present a wide range of clinical manifestations, so underdiagnosis should be avoided. Identifying risk factors, particularly in patients with hospital-acquired diarrhea, is crucial. Factors such as a hospital stay longer than 10 days before symptom onset and in-hospital exposure to PPIs or antibiotics in the last 90 days were significant in our study. Early recognition of these risk factors may reduce hospital stay, lower the risk of complications, and optimize healthcare resources.