Malnutrition as a risk factor for mortality in clostridium difficile infection

Pérez-Cruz, Elizabeth; Sandoval-Flores, María Graciela; Luna-Camacho, Y.; Ortiz-Gutiérrez, Salvador

doi:10.1016/j.clnu.2018.06.1275

Cited by 2 publications

(2 citation statements)

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“…The present study failed to establish a correlation between HO-CDI and underlying peptic ulcer disease, liver disease, inflammatory bowel disease, low levels of vitamin D (rickets), solid tumor without metastasis, and weight loss (malnutrition) as previously described [17,[50][51][52][53][54]. Future clinical studies should explore these associations considering the possibility of increased antibiotic use and hospital admission.…”

Section: Discussioncontrasting

confidence: 59%

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

Mutai

Mureithi

Anzala

et al. 2022

PLOS Glob Public Health

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Introduction Clostridioides difficile is primarily associated with hospital-acquired diarrhoea. The disease burden is aggravated in patients with comorbidities due to increased likelihood of polypharmacy, extended hospital stays and compromised immunity. The study aimed to investigate comorbidity predictors of healthcare facility-onset C. difficile infection (HO-CDI) in hospitalized patients. Methodology We performed a cross sectional study of 333 patients who developed diarrhoea during hospitalization. The patients were tested for CDI. Data on demographics, admission information, medication exposure and comorbidities were collected. The comorbidities were also categorised according to Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Comorbidity predictors of HO-CDI were identified using multiple logistic regression analysis. Results Overall, 230/333 (69%) patients had comorbidities, with the highest proportion being in patients aged over 60 years. Among the patients diagnosed with HO-CDI, 63/71(88.7%) reported comorbidities. Pairwise comparison between HO-CDI patients and comparison group revealed significant differences in hypertension, anemia, tuberculosis, diabetes, chronic kidney disease and chronic obstructive pulmonary disease. In the multiple logistic regression model significant predictors were chronic obstructive pulmonary disease (odds ratio [OR], 9.51; 95% confidence interval [CI], 1.8–50.1), diabetes (OR, 3.56; 95% CI, 1.11–11.38), chronic kidney disease (OR, 3.88; 95% CI, 1.57–9.62), anemia (OR, 3.67; 95% CI, 1.61–8.34) and hypertension (OR, 2.47; 95% CI, 1.–6.07). Among the comorbidity scores, CCI score of 2 (OR 6.67; 95% CI, 2.07–21.48), and ECI scores of 1 (OR, 4.07; 95% CI, 1.72–9.65), 2 (OR 2.86; 95% CI, 1.03–7.89), and ≥ 3 (OR, 4.87; 95% CI, 1.40–16.92) were significantly associated with higher odds of developing HO-CDI. Conclusion Chronic obstructive pulmonary disease, chronic kidney disease, anemia, diabetes, and hypertension were associated with an increased risk of developing HO-CDI. Besides, ECI proved to be a better predictor for HO-CDI. Therefore, it is imperative that hospitals should capitalize on targeted preventive approaches in patients with these underlying conditions to reduce the risk of developing HO-CDI and limit potential exposure to other patients.

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Section: Discussioncontrasting

confidence: 59%

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

Mutai

Mureithi

Anzala

et al. 2022

PLOS Glob Public Health

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“…The NRS is rarely used to assess mortality in CDI. The influence of malnutrition on the course of the disease is more often described [ 27 , 36 ]. In the study by Kyne et al [ 37 ], the authors, in addition to malnutrition, also indicate the influence of other factors, such as: dehydration, fecal incontinence, physical disability, cognitive impairment, and recent endoscopy of the gastrointestinal tract.…”

Section: Discussionmentioning

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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Malnutrition as a risk factor for mortality in clostridium difficile infection

Cited by 2 publications

References 0 publications

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

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

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