Methods: The MN Department of Health performs active, population and laboratory based surveillance for CDI in 5 counties as part of the CDC’s Emerging Infections Program. A CDI case was defined as a positive C. difficiletoxin or molecular assay on a stool specimen from a person without a prior positive assay in the past 8 weeks. Cases were classified as CA if stool was collected ≤3 days of admission or as an outpatient, in a person with no overnight stay in a healthcare facility in the past 12 weeks. Medical records were reviewed and interviews performed to assess healthcare exposures, medications and underlying conditions. Data were compared with the 2011–2012 National Health and Nutrition Examination Survey and 2013 MN Behavioral Risk Factor Surveillance System Survey.
Results: Of 479 patients with CA CDI, 97 (20%) had medically documented clinical depression or antidepressant use, and 24 (5%) had alcohol dependency. When interviewed, 152 (32%) patients reported antidepressant use, 89 (19%) reported clinical depression, and 19 (4%) reported alcohol dependency. The majority of CA CDI patients with documented or self-reported depression or antidepressant use were female (71%), while the majority of those with alcohol dependency were male (59%). Antidepressant use was significantly higher in CA CDI patients than a comparable U.S. population (32% vs. 13%; p<0.001) and alcohol dependency was significantly lower than the general MN population (4% vs. 7.3%; p=.002). The most common antidepressants prescribed were sertraline (16%), citalopram (9%), and fluoxetine (7%).
Conclusion: Depressive disorders and antidepressant usage were common among Minnesota CA CDI patients but alcohol dependency was not. Clinicians treating patients for depressive disorders need to be aware of the increased risk for CDI. Further exploration into the role of depression in C. difficile acquisition is warranted.
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