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.