High delayed mortality after the first episode of Clostridium difficile infection

Cozar, Alberto; Ramos‐Martínez, Antonio; Merino, Esperanza; García, Carmen Isabel Gómez; Shaw, Evelyn; Marrodán, Teresa; Calbo, Esther; Bereciartúa, Elena; Muñoz, Luis Ángel Sánchez; Salavert, Miguel; Pérez-Rodríguez, M. Teresa; García, Dácil; Bravo‐Ferrer, José María; Gálvez-Acebal, Juan; Henríquez, César; Cuquet, Jordi; Gil-Campesino, Helena; Torres, Luís; Sánchez-Porto, Antonio; Royuela, Ana; Cobo, Javier; Romero, J. Zamora; Muriel, Alfonso; Giner, Livia; Federico, Ferrere; Rocío, Martínez-Ruiz S.; Martos, P. García; Sardiña, Cristina; Elena, Aguirre; Badía, Cristina; Perales, Alfonso; Santos-Castro, Pedro Ángel de; Miguel, A. Cebolleo de; Cuéllar, Sandra; Eva, Gonzalez; Llinares, Pedro; Castelo, Laura; Morales, Isabel; Delgado‐Iribarren, Alberto; Mairal, Pilar

doi:10.1016/j.anaerobe.2019.04.004

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Over the last decade, there has been a marked increase in the incidence and severity of CDI, with relapsing episodes now occurring at a higher frequency, especially in the elderly. Notably, recurrent CDI is associated with a significantly higher risk of death within six months after initial CDI treatment completion, compared with CDI patients who do not develop a recurrence [18,19].…”

Section: Discussionmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease—A Novel Risk Factor for Recurrent Clostridioides difficile Infection

et al. 2021

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Recurrent Clostridioides difficile infections (rCDI) have a substantial impact on healthcare systems, with limited and often expensive therapeutic options. Nonalcoholic fatty liver disease (NAFLD) affects about 25% of the adult population and is associated with metabolic syndrome, changes in gut microbiome and bile acids biosynthesis, all possibly related with rCDI. The aim of this study was to determine whether NAFLD is a risk factor associated with rCDI. A retrospective cohort study included patients ≥ 60 years hospitalized with CDI. The cohort was divided into two groups: those who were and were not readmitted with CDI within 3 months of discharge. Of the 329 patients included, 107 patients (32.5%) experienced rCDI. Patients with rCDI were older, had higher Charlson Age–Comorbidity Index (CACI) and were more frequently hospitalized within 3 months. Except for chronic kidney disease and NAFLD, which were more frequent in the rCDI group, there were no differences in other comorbidities, antibiotic classes used and duration of antimicrobial therapy. Multivariable Cox regression analysis showed that age >75 years, NAFLD, CACI >6, chronic kidney disease, statins and immobility were associated with rCDI. In conclusion, our study identified NAFLD as a possible new host-related risk factor associated with rCDI.

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Section: Discussionmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease—A Novel Risk Factor for Recurrent Clostridioides difficile Infection

et al. 2021

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“…Our results are similar to those of other authors. In a multi-center study by Cózar et al [ 5 ], mortality among patients with three aggravating factors, such as heart failure, kidney failure, cancer, diabetes was twice as high as in patients with two factors. Particularly noteworthy are cardiovascular diseases, the presence of which increases the risk of death [ 25 ], especially the presence of ischemic heart disease [ 33 ] or heart failure [ 38 ], in which case mortality increased to approx.…”

Section: Discussionmentioning

confidence: 99%

“…CDI is a severe disease with a high mortality rate [ 5 – 7 ]. Its course is highly variable, from mildly symptomatic cases, requiring only discontinuation of the current antibiotic therapy, to complicated forms, including septic shock.…”

Section: Introductionmentioning

confidence: 99%

Mortality in clostridioides difficile infection among patients hospitalized at the university clinical hospital in Wroclaw, Poland – a 3-year observational study

Drobnik,

Pobrotyn,

Belovičová

et al. 2024

BMC Infect Dis

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Background In the last two decades, a significant increase in the number of Clostridioides difficile infection (CDI) cases has been observed. It is understandable to attempt to determine the factors that can predict the severity of the course of the infection and identify patients at risk of death. This study aimed to analyze the factors affecting the incidence and mortality of CDI in inpatient treatment at the University Clinical Hospital in Wrocław in 2016–2018. Methods Statistical analysis of data obtained from patients’ medical records was performed. Only patients with symptoms of infection and infection confirmed by laboratory tests were enrolled in the study. When analyzing the number of deaths, only adult patients who died in hospital wards were included. The quantitative data including laboratory tests, used antibiotics and Nutritional Risk Screening (NRS) were assessed. Also, the qualitative data such as sex, year of hospitalization, occurrence of diarrhoea on admission to the hospital, presence of additional diseases, as wee ad the use of antibacterial drugs or proton pump blockers and ranitidine during hospitalization were analyzed. Results A total of 319 adult CDI patients (178 women and 141 men) were enrolled of which 80 people died (50 women and 30 men). The mean age of the patients was 72.08 ± 16.74 years. Over the entire period studied, the morbidity was 174 cases per 100,000 hospitalizations while mortality was 25.08%. The group of deceased patients was characterized by: older age (by 9.24 years), longer duration of hospitalization (by 10 days), reduced albumin levels (Rho = -0.235, p < 0.001), higher urea levels, use of more antibiotics, higher risk of malnutrition in NRS (Rho = 0.219, p < 0.001), higher incidence of sepsis, heart failure, stroke, hypothyroidism. Pneumonia was diagnosed twice as often. It was also shown that deceased patients were significantly more likely to take penicillin and fluoroquinolones. Conclusions In this study, the morbidity was lower, but mortality was higher compared to similar hospitals in Poland. CDI patients were characterized by older age, multimorbidity, extended hospitalization, and the use of broad-spectrum antibiotics. Risk factors for death included advanced age, prolonged hospital stays, lower albumin, higher urea, malnutrition, and comorbidities like heart failure, stroke, pneumonia, sepsis, and hypothyroidism. Increased antibiotic use, particularly penicillin and fluoroquinolones, was associated with a higher mortality risk.

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“…Our study shows that this late mortality is even higher in cancer patients. CDI is a devastating illness, causing long hospitalizations, immobilization, long-term dysbiosis, and potential delay in scheduled chemotherapy cycles (Cózar et al, 2019) (Dutta and Lim, 2020). All these features may explain the higher late mortality in this group.…”

Section: Discussionmentioning

confidence: 99%

Late poor outcomes of Clostridioides difficile infections in oncological patients: A multicentre cohort study

Calbo

Hernández²,

Sopena

et al. 2023

Journal of Infection Prevention

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Background Cancer has been associated with an increased risk of in-hospital mortality in CDI patients. However, data on delayed mortality in cancer patients with CDI are scarce. Aim/Objective The aim of the present study was to compare outcomes between oncological patients and the general population with Clostridioides difficile infection (CDI) after 90 days of follow-up. Methods A multicenter prospective cohort study was conducted in 28 hospitals participating in the VINCat program. Cases were all consecutive adult patients who met the case definition of CDI. Sociodemographic, clinical, and epidemiological variables and evolution at discharge and after 90 days were recorded for each case. Findings/results The mortality rate was higher in oncological patients (OR = 1.70, 95% CI: 1.08–2.67). In addition, oncological patients receiving chemotherapy (CT) presented higher recurrence rates (18.5% vs 9.8%, p = 0.049). Among oncological patients treated with metronidazole, those with active CT showed a higher rate of recurrence (35.3% vs 8.0% p = 0.04). Discussion Oncological patients presented a higher risk of poor outcomes after CDI. Their early and late mortality rates were higher than in the general population, and in parallel, those undergoing chemotherapy (especially those receiving metronidazole) had higher rates of recurrence

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High delayed mortality after the first episode of Clostridium difficile infection

Cited by 5 publications

References 32 publications

Nonalcoholic Fatty Liver Disease—A Novel Risk Factor for Recurrent Clostridioides difficile Infection

Nonalcoholic Fatty Liver Disease—A Novel Risk Factor for Recurrent Clostridioides difficile Infection

Mortality in clostridioides difficile infection among patients hospitalized at the university clinical hospital in Wroclaw, Poland – a 3-year observational study

Late poor outcomes of Clostridioides difficile infections in oncological patients: A multicentre cohort study

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