The study team worked to identify host and clinical risk factors contributing to the development of Clostridioides difficile infection (CDI) among colonized patients.
Among 2,212 colonized patients, 71 cases and 133 matched controls were identified. Several host and clinical characteristics were independently associated with progression to CDI in our multivariate model. Notably, high-risk antibiotic use across the pre-exposure and exposure periods was associated with greater odds of progression to CDI compared to other patterns of antibiotic use (adjusted odds ratio 2.70; P = .03).
Sustained exposure to high-risk antibiotics was a strong predictor of the progression from C. difficile colonization to infection, underscoring the need for further research on longitudinal stewardship strategies for CDI prevention, particularly among patients previously identified as colonized.