Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection

Chintanaboina, Jayakrishna; Navabi, Seyedehsan; Suchniak-Mussari, Kristen; Stern, Benjamin; Bedi, Simranjit; Lehman, Erik; Tinsley, Andrew

doi:10.14423/smj.0000000000000687

Cited by 12 publications

(6 citation statements)

References 20 publications

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“…We confirm that increasing age is an important risk factor for a fatal outcome of CDI, as described previously [ 20 , 21 ]. A systematic review which included 30 studies showed that increasing age is among the most reported risk factor for mortality in patients with CDI [ 22 ].…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, the elderly are characterized by a greater number of chronic diseases, including those that contribute to a worse course of CDI, such as chronic kidney disease, diabetes, or malignancy [ 23 ]. Gender is not an important factor since the risk was similar for both males and females, as described in other studies [ 21 , 24 , 25 ].…”

Section: Discussionsupporting

confidence: 71%

“…The presence of any comorbidity (p < 0.0001) and increasing Charlson Index (p = <0.0001) were also associated with increased mortality. This has been described elsewhere [20,21,26], but some studies did not confirm such observations [27]. This may be the result of the different characteristics of the population or study design.…”

Section: Discussionmentioning

confidence: 84%

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Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study

et al. 2021

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We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 71%

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Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study

et al. 2021

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“…The IDSA‐SHEA 7 and World Society of Emergency Surgery 37 reviewed their guidelines recently. The other guidelines are American College of Gastroenterology 2013, 38 European Society of Clinical Microbiology and Infectious Diseases 2014, 39 and Australasian Society of Infectious Diseases 2016 40 . The commonest severe CDI criteria in clinical guidelines were raised white blood cells, followed by low albumin and raised creatinine level.…”

Section: Resultsmentioning

confidence: 99%

Systematic review on the definition and predictors of severe Clostridiodes difficile infection

Zhang

Woo

Scaduto

et al. 2020

J of Gastro and Hepatol

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Clostridiodes difficile infection (CDI) is one of the most common hospital‐acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty‐three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non‐mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi‐center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.

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“…However, when the authors differentiated studies according to methodology and quality of study, they identified age and the presence of comorbidities as the two most common severity predictors for CDI. CCI score was frequently used to assess comorbidity burden in several of the included studies [34][35][36][37][38]. Interestingly, even though the role of leukocytosis in severity classification is widely recognized, age and comorbidities (as depicted by validated scores such as the CCI score) are not included in any of the currently available international guidelines to define severe disease.…”

Section: Discussionmentioning

confidence: 99%

Treatment and Outcomes of Clostridioides difficile Infection in Switzerland: A Two-Center Retrospective Cohort Study

Filippidis

Kampouri

Woelfle

et al. 2022

JCM

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Objectives: Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, often complicated by severe infection and recurrence with increased morbidity and mortality. Data from large cohorts in Switzerland are scarce. We aimed to describe diagnostic assays, treatment, outcomes, and risk factors for CDI in a large cohort of patients in Switzerland. Methods: We conducted a retrospective cohort study of CDI episodes diagnosed in patients from two tertiary care hospitals in Switzerland. During a 3-month follow-up, we used a composite outcome combining clinical cure at day 10, recurrence at week 8, or death, to evaluate a patient’s response. Unfavorable outcomes consisted in the occurrence of any of these events. Results: From January 2014 to December 2018, we included 826 hospitalized patients with documented CDI. Overall, 299 patients (36.2%) had a severe infection. Metronidazole was used in 566 patients (83.7%), compared to 82 patients (12.1%) treated with vancomycin and 28 patients (4.1%) treated with fidaxomicin. Overall mortality at week 8 was at 15.3% (112/733). Eighty-six patients (12.7%) presented with clinical failure at day 10, and 78 (14.9%) presented with recurrence within 8 weeks; 269 (39.8%) met the composite outcome of death, clinical failure, or recurrence. The Charlson Comorbidity Index score (p < 0.001), leukocytes >15 G/L (p = 0.008), and the use of metronidazole (p = 0.012) or vancomycin (p = 0.049) were factors associated with the composite outcome. Conclusions: Our study provides valuable insights on CDI treatment and outcomes in Switzerland, highlights the heterogeneity in practices among centers, and underlines the need for the active monitoring of clinical practices and their impact on clinical outcomes through large multicentric cohorts.

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Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection

Abstract: Advanced age, Charlson comorbidity index, intensive care unit status, and peptic ulcer disease are predictors of all-cause 30-day mortality in hospitalized patients with CDI.

Cited by 12 publications

References 20 publications

Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study

Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study

Systematic review on the definition and predictors of severe Clostridiodes difficile infection

Treatment and Outcomes of Clostridioides difficile Infection in Switzerland: A Two-Center Retrospective Cohort Study

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