Risk Factors for Early Recurrent Clostridium difficile-Associated Diarrhea

• Published in: Clinical infectious diseases Vol. 26; no. 4; pp. 954 - 959
• Main Authors: Do, Ann N., Fridkin, Scott K., Yechouron, Ariane, Banerjee, Shailen N., Killgore, George E., Bourgault, Anne Marie, Jolivet, Marie, Jarvis, William R.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.04.1998; University of Chicago Press
• Subjects: Adult; Aged; Aged, 80 and over; Antimicrobials; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Case-Control Studies; Chronic diseases; Chronic renal insufficiency; Clinical Articles; Clostridium; Clostridium difficile; Clostridium difficile - isolation & purification; Colitis; Cross Infection; Diarrhea; Diarrhea - microbiology; Diarrhea - physiopathology; Diseases; Female; Human bacterial diseases; Humans; Infectious diseases; Kidney Failure, Chronic; Male; Medical sciences; Middle Aged; Predisposing factors; Recurrence; Risk Factors; Toxins; Human; Relapse; Clostridium difficile; Clostridiales; Diarrhea; Infection; Prevention; Clostridiaceae; Risk factor; Bacteriosis; Digestive diseases; Bacteria; Intestinal disease; Early
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/513952

Recurrence is a common sequela of Clostridium difficile-associated diarrhea (CDD) and may increase morbidity, costs, and treatment-related antimicrobial resistance. Because recurrent CDD (RCDD) frequently occurs very soon after an initial episode, our goal was to determine the risk factors for early RCDD (occurring ⩽45 days after the initial episode). We conducted a case-control study, comparing 13 patients with early RCDD (case patients) with 46 patients who had only one CDD episode (control patients) at Centre Hospitalier Angrignon (Québec) during January 1993 through November 1994. Risk factors for early RCDD included a history of chronic renal insufficiency, a white blood cell count of ⩾15 1 103/mm3, and community-acquired diarrhea with the first CDD episode. For seven of eight case patients, C. difficile strains from the first and second CDD episodes were identical, suggesting that relapse is more common than reinfection. These results suggest that treatments should be directed at preventing relapses in patients at high risk for early RCDD.