Evaluation of a risk score to predict future Clostridium difficile disease using UK primary care and hospital data in Clinical Practice Research Datalink

Abstract

We evaluated the applicability of a Clostridium difficile infection (CDI) risk index developed for patients at hospital discharge to identify persons at high-risk of CDI in a primary care population. This retrospective observational study used data from the UK Clinical Practice Research Datalink, linked with Hospital Episodes Statistics. The risk index was based on the following patient characteristics: age, previous hospitalizations, days in hospital, and prior antibiotics use. Individual risk scores were calculated by summing points assigned to pre-defined categories for each characteristic. We assessed the association of risk factors with CDI by multivariate logistic regression. The estimated CDI incidence rate was 4/10,000 and 2/10,000 person-years in 2008 and 2012, respectively. On an index with a maximal risk of 19, a cut-off for high risk of ≥7 had sensitivity, specificity and positive predictive values of 80%, 87% and 12%, respectively. A high-risk person had a ~ 35% higher risk of CDI than a low-risk person. Multivariate risk factor analysis indicated a need to reconsider the relative risk scores. The CDI risk index can be applied to the UK primary care population and help identify study populations for vaccine development studies. Reassessing the relative weights assigned to risk factors could improve the index performance in this setting.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

“…1,45 The strongest risk factor for developing CDI is recent antibiotic use (within 3 months), and increased duration of exposure and number of antibiotics used are associated with higher risk for developing CDI. 9,43,[46][47][48] Although most antibiotics can change the colonic bacterial milieu leading to dysbiosis, drugs such as clindamycin, ampicillin, penicillin with beta-lactamase inhibitors, fluoroquinolones, and thirdgeneration cephalosporins are more commonly associated with developing CDI. 46,49 Other risk factors for CDI include having contact with a health care facility whether as an inpatient or an outpatient.…”

New generation biologics for the treatment of psoriasis and psoriatic arthritis. State of the art and considerations about the risk of infection

“…They show that age older than 65 years and Hyspanic race are risk factors for CDI in febrile neutropenia 39 . Moreover, in a study by Marley et al it is shown that having been hospitalized within 90 days from the CDI onset, having used 4 or more classes of antibiotics in the same time frame and an age over 75 years are the independent risk factors with the highest association to the onset of CDI 41 …”

“…39 Moreover, in a study by Marley et al it is shown that having been hospitalized within 90 days from the CDI onset, having used 4 or more classes of antibiotics in the same time frame and an age over 75 years are the independent risk factors with the highest association to the onset of CDI. 41 With regards to the use of drugs which modulates the immune system, and in particular the IL-23/IL-17 axis, conflicting evidences exist. IL-17 has a role in immune defense against extracellular bacterial and fungal infections.…”

Can prediction scores be used to identify patients at risk of Clostridioides difficile infection?

“…The highest AUROC achieved was a modest 0.75. Marley et al [28] validated the Baggs score in a UK-based cohort of over 2 million individuals drawn from a general, mostly outpatient population with a 1-year cumulative CDI incidence of only 0.02%. The overall AUROC was 0.89, and using a cutoff of at least 7 yielded a sensitivity of 80% and specificity 87%.…”