Nonalcoholic fatty liver disease as a risk factor for Clostridioides difficile infection


Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea while nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. The aim of this study was to determine whether NAFLD increases susceptibility to CDI. A retrospective cohort study included patients ≥ 65 years, treated with antimicrobial therapy ≥ 24 h, and hospitalized ≥ 72 h in a 36-month period. Three-hundred fourteen patients were included; 83 with NAFLD and 231 controls. Except for diabetes mellitus (37.35% vs. 25.11%, p = 0.0462) and obesity (18.07% vs. 8.23%, p = 0.0218) that were more frequent in NAFLD group, there were no differences in other comorbidities, hospital admissions, antibiotic therapy within 3 months, prescription, and duration of antibiotic therapy. Fourteen (16.9%) patients with NAFLD and 17 (7.4%) in control group developed in-hospital CDI (p = 0.0156). The Charlson Age-Comorbidity Index > 6 (OR 4.34, 95%CI 1.39–13.57), hospital admission within 3 months (OR 7.14, 95%CI 2.33–21.83), serum albumins < 28 g/L (OR 3.15, 95%CI 1.04–9.53), NAFLD (OR 3.27, 95%CI 1.04–10.35), eGFR < 40 (OR 4.89, 95%CI 1.61–14.88), treatment with piperacillin/tazobactam (OR 4.86, 95%CI 1.59–14.83), and carbapenems (OR 3.99, 95%CI 1.28–12.40) were independently associated with CDI. Our study identified NAFLD as an independent predictor of CDI.

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Author information




All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Neven Papić, Lorna Stemberger Marić, Fabijan Jelovčić, and Marko Karlović. The first draft of the manuscript was written by Neven Papić, Fabijan Jelovčić, and Marko Karlović and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Neven Papić.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethical committee (Ethical committee University Hospital for Infectious Diseases Zagreb) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Papić, N., Jelovčić, F., Karlović, M. et al. Nonalcoholic fatty liver disease as a risk factor for Clostridioides difficile infection. Eur J Clin Microbiol Infect Dis 39, 569–574 (2020).

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  • NASH
  • Clostridioides difficile
  • associated disease
  • Healthcare-associated diarrhea
  • Nosocomial infections