{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:10:26Z","timestamp":1785431426099,"version":"3.56.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,3]]},"abstract":"Abstract<\/jats:title>\n \n Objective:<\/jats:title>\n \n To identify host and clinical risk factors contributing to the development of\n Clostridioides difficile<\/jats:italic>\n infection (CDI) among colonized patients.\n <\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective, matched case-control study.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Duke University Health System, including 3 hospitals and affiliated outpatient clinics.<\/jats:p>\n <\/jats:sec>\n \n Participants:<\/jats:title>\n \n Adult patients who underwent \u22652 two-step\n C. difficile<\/jats:italic>\n tests (nucleic acid amplification test (NAAT) followed by toxin enzyme immunoassay) between 03\/15\/2020\u201312\/31\/2023. Cases were patients with\n C. difficile<\/jats:italic>\n colonization (NAAT+\/toxin\u2013) who converted to CDI (NAAT+\/toxin+) within 90 days; controls were colonized patients who remained toxin-negative. Cases were matched to controls by date of index testing (\u00b11 year).\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Data collection encompassed a 90-day \u201cpre-exposure\u201d period preceding index testing and a \u2264 90-day \u201cexposure\u201d period between index and repeat testing. Antibiotic use was stratified by risk for each period. Multivariate conditional logistic regression with forward selection was used to identify predictors of progression.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n 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;\n P<\/jats:italic>\n = .03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n Sustained exposure to high-risk antibiotics was a strong predictor of the progression from\n C. difficile<\/jats:italic>\n colonization to infection, underscoring the need for further research on longitudinal stewardship strategies for CDI prevention, particularly among patients previously identified as colonized.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1017\/ice.2025.10377","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T06:51:06Z","timestamp":1766127066000},"page":"265-271","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Risk factors for progression from\n Clostridioides difficile<\/i>\n colonization (NAAT+\/toxin\u2013) to infection (toxin+) following symptomatic retesting"],"prefix":"10.1017","volume":"47","author":[{"given":"Sophia","family":"Chang","sequence":"first","affiliation":[{"name":"Duke University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0650-4894","authenticated-orcid":false,"given":"Nicholas","family":"Turner","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University Medical Center"},{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-1519","authenticated-orcid":false,"given":"Michael","family":"Yarrington","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University Medical Center"},{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-5496","authenticated-orcid":false,"given":"Deverick","family":"Anderson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke University Medical Center"},{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"S0899823X25103772_ref15","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3414\/ME17-01-0051","article-title":"The Charlson comorbidity index in registry-based research","volume":"56","author":"Brusselaers","year":"2017","journal-title":"Methods Inf Med"},{"key":"S0899823X25103772_ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.4114"},{"key":"S0899823X25103772_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf020"},{"key":"S0899823X25103772_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2023.11.022"},{"key":"S0899823X25103772_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00236-3"},{"key":"S0899823X25103772_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2021.09.026"},{"key":"S0899823X25103772_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz626"},{"key":"S0899823X25103772_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2018.02.013"},{"key":"S0899823X25103772_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2020.431"},{"key":"S0899823X25103772_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2016.06.005"},{"key":"S0899823X25103772_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2010.11.008"},{"key":"S0899823X25103772_ref3","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001278"},{"key":"S0899823X25103772_ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1306801"},{"key":"S0899823X25103772_ref6","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00021-17"},{"key":"S0899823X25103772_ref9","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.22"},{"key":"S0899823X25103772_ref21","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1134369"},{"key":"S0899823X25103772_ref4","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2023.18"},{"key":"S0899823X25103772_ref1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1801550"},{"key":"S0899823X25103772_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-023-00856-4"},{"key":"S0899823X25103772_ref5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012413"},{"key":"S0899823X25103772_ref13","doi-asserted-by":"publisher","DOI":"10.1086\/521859"},{"key":"S0899823X25103772_ref7","first-page":"149","article-title":"Screening of Clostridioides difficile carriers in an urban academic medical center: understanding implications of disease","volume":"41","author":"Baron","year":"2020","journal-title":"Infect Control Hosp Epidemiol."}],"container-title":["Infection Control & Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X25103772","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:33:34Z","timestamp":1771929214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X25103772\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["S0899823X25103772"],"URL":"https:\/\/doi.org\/10.1017\/ice.2025.10377","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}