Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

• Published in: Journal of pharmacy & pharmaceutical sciences Vol. 19; no. 3; pp. 349 - 356
• Main Authors: Carpenter, Bethanne P, Hennessey, Erin K, Bryant, Alex M, Khoury, Jad A, Crannage, Andrew J
• Format: Journal Article
• Language: English
• Published: Canada Frontiers Media S.A 01.07.2016
• Subjects: Aged; Anti-Bacterial Agents - pharmacology; Case-Control Studies; Clostridium difficile - drug effects; Clostridium difficile - genetics; Clostridium Infections - diagnosis; Clostridium Infections - drug therapy; Female; Humans; Male; Polymerase Chain Reaction; Regression Analysis; Retrospective Studies; Risk Factors
• ISSN: 1482-1826; 1482-1826
• DOI: 10.18433/J32S41

Recurrent Clostridium difficile infection (RCDI) is a growing concern, yet limited data exists to clarify which patients are at highest risk.  Identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. The purpose of this study was to determine which factors are associated with the recurrence of Clostridium difficile infection (CDI) and to develop a risk stratification tool.  Methods. Patients readmitted within 10 weeks of positive C. difficile polymerase chain reaction (PCR) with symptoms were included in this retrospective case control study.  The primary outcome was analyzed via univariate regression analyses of the independent factors including age, gender, number of CDI episodes, administration of acid blocking agents, antibiotics or chemotherapy, Charlson Comorbidity Index, gastrointestinal conditions, and exposure to healthcare facilities.  Results. Recurrent CDI was identified in 44 of 220 included patients.  In the univariate analysis, factors associated with development of RCDI included antibiotic exposure (OR 2.51, 95% CI 1.14-5.54; p 0.02) and inflammatory bowel disease (OR 5.77, 95% CI 1.24-26.79; p 0.03).  An evaluation tool was created from a well-fit model.  Additional factors included in the tool were chosen based on evaluation of findings from existing literature.  Conclusions. Antibiotic therapy and inflammatory bowel disease were found to be associated with RCDI.  Although a statistically significant association with RCDI was not found for other factors, this is likely related to small sample size.  The creation of an evaluation tool using specific patient factors can help determine the risk of RCDI, while future studies may validate this tool. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.