Predicting Clostridium difficile infection in diabetic patients and the effect of metformin therapy: a retrospective, case–control study

N. Eliakim-Raz, G. Fishman, D. Yahav, E. Goldberg, G. Y. Stein, H. B. Zvi, A. Barsheshet, J. Bishara

Research output: Contribution to journalArticlepeer-review

Abstract

Data on risk factors for Clostridium difficile infection (CDI) in diabetic patients are scarce. Recently, it has been shown that metformin increases the Bacteroidetes/Firmicutes ratio; therefore, it may yield a protective effect against CDI. We aimed to assess risk factors for CDI in diabetic patients beyond antibiotic treatment, and to determine the impact of metformin therapy on the development of CDI in these patients. In this retrospective, case–control study, all consecutive CDI diabetic patients, from January 2009 to December 2013, were included and compared to consecutive diabetic patients without CDI, hospitalized during the same period and in the same departments. Of 7,670 patients tested for C. difficile toxins, 486 were diabetics. Of them, 150 (30.8 %) were positive for C. difficile toxins and 336 (69.1 %) were negative. On multivariate analysis, metformin treatment was associated with a significant reduction in CDI [odds ratio (OR) = 0.58; 95 % confidence interval (CI), 0.37–0.93; p = 0.023], while heart failure was associated with significantly higher rates of CDI (OR = 1.654; 95 % CI, 1.007–2.716; p = 0.047), together with poor functional status, previous hospitalization, and abdominal surgery. Our findings suggest that, in diabetic patients, in addition to the well-recognized risk factors, heart failure is an additional risk factor for CDI, while metformin treatment seems to have a protective effect against the development of CDI. The exact mechanisms underlying this protective effect remain to be fully understood.

Original languageEnglish
Pages (from-to)1201-1205
Number of pages5
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume34
Issue number6
DOIs
StatePublished - 1 Jun 2015

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