Risk Factors for Recurrent Clostridium difficile Infection Open Access
Reddy, Sujan Chollati (2015)
Introduction: Identifying patients at high risk for recurrent Clostridium difficile infection (CDI) is important. Exposures to healthcare facilities and CDI treatment are of particular interest as these factors are readily identifiable and potentially modifiable by clinicians.
Methods: Population based surveillance for CDI was performed in ten states. Initial CDI cases were defined as an initial positive C. difficile test identified between January and December 2013 in a patient with diarrhea or CDI treatment who did not have any previous documented CDI in surveillance. A recurrent case was defined as a positive test over 14 days from the previous positive test in a patient who had diarrhea or CDI treatment for that recurrent positive test. Patients over the age of 17 were included. Patients who did not have documentation of symptoms or treatment were excluded as were patients who died after initial CDI.
Results: A total of 4,790 adults with initial CDI were included in the analysis. Recurrent CDI was identified in 843 patients (17%). Hospital-onset (HO) CDI was not associated with increased risk of recurrence compared to community associated (CA) CDI in bivariate nor in multivariate analysis (p>0.05). In multivariate analysis, factors associated with increased risk of recurrence included: treatment with combination vancomycin and metronidazole, age over 65 years, female sex, white race, hemodialysis use, diabetes, and prior antibiotic use (p<0.05). Long term care facility onset (LTCFO) cases had a non-significant increased risk of recurrence compared to community associated disease (p=0.18). There was no difference in recurrence risk noted in patients treated with vancomycin compared to those treated with metronidazole (p=0.23).
Conclusion: HO and CA CDI have similar and relatively high risk of recurrence. Recurrence risk among LTCFO cases warrants further study. Treatment with either vancomycin or metronidazole did not affect recurrence risk.
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