First recurrence of Clostridium difficile infection: clinical relevance, risk factors, and prognosis

Abstract

Therapy for recurrent Clostridium difficile-associated diarrhea (CDAD) is challenging. We evaluated the frequency, associated risk factors, and prognosis of first CDAD recurrences. Prospective cohort study of all consecutive cases of primary CDAD diagnosed in a university hospital from January 2006 to June 2013. Recurrent infection was defined as reappearance of symptoms within 8 weeks of the primary diagnosis, provided that CDAD symptoms had previously resolved and a new toxin test was positive. Predictors of a first episode of recurrent CDAD were determined by logistic regression analysis. In total, 502 patients (51.6 % men) with a mean age of 62.3 years (SD 18.5) had CDAD; 379 (76 %) were cured, 61 (12 %) had a first recurrence, 52 (10 %) died within 30 days of the CDAD diagnosis, nine (2 %) required colectomy, and one was lost to follow-up. Among the 61 patients with a first recurrence, 36 (59.3 %) were cured, 15 (23.7 %) had a second recurrence, nine (15.3 %) died, and one (1.7 %) required colectomy. On multivariate analysis, age older than 65 years (OR 2.04; 95 % CI, 1.14-3.68; P < 0.02) and enteral nutrition (OR, 3.62; 95%CI, 1.66-7.87; P < 0.01) were predictors of a first recurrence. A risk score was developed for first CDAD recurrence using the predictive factors and selected biological variables. In our CDAD cohort, 12 % of patients had a first recurrence of this disease, in which the prognosis was less favorable than that of the primary episode, as it heralded a higher risk of additional recurrences. Patient age and enteral nutrition were predictors of a first recurrence.

Cost-Effectiveness Analysis of Bezlotoxumab Added to Standard of Care Versus Standard of Care Alone for the Prevention of Recurrent Clostridium difficile Infection in High-Risk Patients in Spain

“…The risk of colectomy and the mortality risk in patients requiring colectomy were based on a prospective cohort Spanish study [ 26 ], whose aim was to evaluate the frequency, associated risk factors and prognosis of first CDAD recurrences, and a literature review [ 27 ].…”

A Comparison of Current Guidelines of Five International Societies on Clostridium difficile Infection Management

“…More recent studies greatly support these previous results, but also name additional risk factors for recurrent CDI not mentioned by any of the current guidelines. In a retrospective, but very extensive cohort, steroid treatment was found to be associated with recurrent CDI [ 79 ], and a very recent prospective cohort identified enteral tube nutrition as another independent predictor of recurrence [ 80 ]. In another report on a retrospective cohort of more than 750 patients, the authors found a longer hospital stay to independently predict recurrent CDI [ 81 ], and there is growing evidence that inflammatory bowel disease may also predispose to CDI recurrence [ 82 ].…”

Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spaish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

“…In the European EU-CLID study, that followed the methodogy of the Spanish Studies, the mean number of CDI episodes was of 7 episodes of CDI per 10,000 patient-bed days and it was estimated that 23% of the cases were missed [12]. Most cases described in Spain have mild or moderate severity, are health care-associated, and have a recurrence frequency ranging from 12% to 18% [6,11,13].…”