Recurrent Clostridium difficile infection: A review of risk factors, treatments, and outcomes

Johnson, Stuart

doi:10.1016/j.jinf.2009.03.010

Cited by 326 publications

(278 citation statements)

References 55 publications

(56 reference statements)

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“…Up to 40-65% of patients will have another episode of CDI when that time period is extended to several years in the presence of multiple risk factors such as repeated exposure to healthcare and broad spectrum antibiotics (1,(3)(4)(5)(6)(7). The majority of epidemiology literature defines recurrence as CDI within the first two months of the initial episode (4)(5)(7)(8).…”

Section: Clostridium Difficile Infection (Cdi) Occurs Whenmentioning

confidence: 99%

“…There is currently no accepted systematic method to determine or stratify the risk of development of RCDI, but there is an abundance of retrospective and surveillance literature citing several factors associated with the development of both an initial episode of CDI and RCDI. Factors shown to repeatedly correlate with RCDI were increasing age (≥ 65 years old), antibiotic therapy, and concomitant use of acid-suppressing medications (proton-pump inhibitors most frequently studied) (5)(6)(7)(12)(13)(14)(15)(16). While these factors were the most commonly cited, there are many other factors individually studied and found to be independently associated with CDI/RCDI including obesity, intraabdominal or gastrointestinal surgery, tube feedings or nasogastric tubes, inflammatory bowel disease (IBD), and immunocompromising disease states or medications (1,4,(17)(18)(19)(20)(21).…”

Section: Clostridium Difficile Infection (Cdi) Occurs Whenmentioning

confidence: 99%

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Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

et al. 2016

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-Purpose. Recurrent Clostridium difficile infection (RCDI) is a growing concern, yet limited data exists to clarify which patients are at highest risk. Identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. The purpose of this study was to determine which factors are associated with the recurrence of Clostridium difficile infection (CDI) and to develop a risk stratification tool. Methods. Patients readmitted within 10 weeks of positive C. difficile polymerase chain reaction (PCR) with symptoms were included in this retrospective case control study. The primary outcome was analyzed via univariate regression analyses of the independent factors including age, gender, number of CDI episodes, administration of acid blocking agents, antibiotics or chemotherapy, Charlson Comorbidity Index, gastrointestinal conditions, and exposure to healthcare facilities. Results. Recurrent CDI was identified in 44 of 220 included patients. In the univariate analysis, factors associated with development of RCDI included antibiotic exposure (OR 2.51, 95% CI 1.14-5.54; p 0.02) and inflammatory bowel disease (OR 5.77, 95% CI 1.24-26.79; p 0.03). An evaluation tool was created from a well-fit model. Additional factors included in the tool were chosen based on evaluation of findings from existing literature. Conclusions. Antibiotic therapy and inflammatory bowel disease were found to be associated with RCDI. Although a statistically significant association with RCDI was not found for other factors, this is likely related to small sample size. The creation of an evaluation tool using specific patient factors can help determine the risk of RCDI, while future studies may validate this tool.

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Section: Clostridium Difficile Infection (Cdi) Occurs Whenmentioning

confidence: 99%

Section: Clostridium Difficile Infection (Cdi) Occurs Whenmentioning

confidence: 99%

Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

et al. 2016

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“…Clostridium species may asymptomatically colonize the intestine or may lead to inflammation with fulminant colitis, accompanied by clinical deterioration. Nearly 20 % of patients with initial CDI will develop symptomatic recurrence, with effectively double the risk for developing future infections [5]. The results of Dr. Sun's study unexpectedly show that this is not necessarily true in the subset of patients who had undergone total proctocolectomy.…”

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confidence: 99%

Understanding New Concepts: Clostridium difficile Infection in Pouch Patients

Gurvits

2014

Dig Dis Sci

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“…Relapses may follow an initial infection in about 20% of cases 25 , and rates of subsequent relapses can rise to 40-60% 26 . While these recurrences may be caused by relapsing infection with the same strain, it has been suggested that between 33-75% of cases may be due to infection with a new strain 25 .…”

mentioning

confidence: 99%

“…While these recurrences may be caused by relapsing infection with the same strain, it has been suggested that between 33-75% of cases may be due to infection with a new strain 25 .…”

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confidence: 99%

The complex factors that contribute to Clostridium difficile infection

Mackin

Lyras

2015

Microbiol. Aust.

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Over the past decade Clostridium difficile has emerged as a serious public health issue, causing both hospital-based epidemics and community-associated disease. The most commonly recognised cause of antibiotic-associated diarrhoea in the human population, C. difficile was initially seen as a nuisance pathogen causing limited disease in the hospital setting. However, the emergence of ‘hypervirulent' strain types, associated with an increase in both morbidity and mortality, has made it a pathogen of great concern worldwide. Infection with C. difficile is also being increasingly documented in animals, with suggestions that animals destined for human consumption may provide a reservoir for disease. The use of antibiotics is considered the main risk factor for the development of human infection; however, many other factors such as strain type, patient age, and host immune response all contribute to disease caused by C. difficile.

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Recurrent Clostridium difficile infection: A review of risk factors, treatments, and outcomes

Cited by 326 publications

References 55 publications

Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

Understanding New Concepts: Clostridium difficile Infection in Pouch Patients

The complex factors that contribute to Clostridium difficile infection

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