Development and Validation of a Clostridium difficile Infection Risk Prediction Model

Abstract

Objective The purpose of this study was to develop and validate a risk prediction model that could identify patients at high risk for Clostridium difficile infection (CDI) before they develop disease. Design Retrospective cohort. Setting Tertiary care medical center. Patients Patients admitted to the hospital for ≥48 hours from 1-1-2003 through 12-31-2003. Methods Data were collected electronically from the hospital’s Medical Informatics database and analyzed with logistic regression to determine variables that best predicted patients’ risk for development of CDI. Model discrimination and calibration were calculated. The model was bootstrapped 500 times to validate the predictive accuracy. A receiver operating characteristic (ROC) curve was calculated to evaluate potential risk cut-offs. Results 35,350 admissions with 329 CDI cases were included. Variables in the risk prediction model were age, CDI pressure, admissions in previous 60 days, modified Acute Physiology Score, days on high risk antibiotics, low albumin, admission to an ICU, and receipt of laxatives, gastric acid suppressors, or antimotility drugs. The calibration and discrimination of the model were very good to excellent (C index=0.88; Brier score 0.009). Conclusions The CDI risk prediction model performed well. Further study is needed to determine if it could be used in a clinical setting to prevent CDI-associated outcomes and reduce costs.

Prevalence and Duration of Asymptomatic Clostridium difficile Carriage among Healthy Subjects in Pittsburgh, Pennsylvania

“…Three (33%) of 9 stool specimens from healthy C. difficile-colonized individuals were positive by a commonly used commercial nucleic acid test for C. difficile. These data reinforce the notion that nucleic acid-based C. difficile assays lack specificity and may overdiagnose CDIs in lower-risk populations when additional clinical criteria are not considered or when testing for other enteric pathogens is not performed (20,21).…”

Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

“…[11][12][13] Prognostic risk modeling has been used less frequently for infectious diseases; however, a number of risk prediction scores have been created to identify risk for incident and recurrent CDI among hospitalized patients. [14][15][16][17][18][19] In contrast to previous efforts, our risk score was developed to predict risk upon admission specifically to aid in decision making and targeting of antimicrobial stewardship efforts. This simple, reliable, and accurate tool will enable antimicrobial stewardship programs to use combinations of predictors to estimate the probability that CDI will occur in the next six months, and to identify patients for whom intensive antimicrobial review and stewardship efforts may be beneficial.…”

Clostridium difficile in the ICU

“…CDI pressure is a risk factor for CDI. 32 CDI pressure is analogous to colonization pressure where the more patients with CDI in a given patient care area, the greater the risk that other patients will develop CDI. The intensivist also should recognize that there is an increase in community-associated CDI in patients with no recent exposure to the health-care system in Canada, England, and some regions of the United States.…”