Risk factors for poor outcome in community-onset Clostridium difficile infection

Lee, Eunyoung; Song, Kyoung Ho; Bae, Jae‐Young; Yoon, Doran; Hwang, Joo-Hee; Choe, Pyoeng Gyun; Park, Wan Beom; Bang, Ji Hwan; Kim, Eu Suk; Park, Sang Won; Kim, Nam Joong; Oh, Myoung‐don; Kim, Hong Bin

doi:10.1186/s13756-018-0365-6

Cited by 17 publications

(12 citation statements)

References 27 publications

(32 reference statements)

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“…When judging by the history of antibiotics use, laxative use, shock, ileus, and, the number of diarrhoea, the proportion of appropriate CDI testing in community-onset was 46.8%. In Korea, 12.1% of CDI were reported to be community-onset CDI [ 22 ]. Similarly, in the Asia–Pacific region, 16.5% of CDI was community-associated [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with inappropriate Clostridioides difficile testing in a teaching hospital in Korea

Ham

Jung

et al. 2022

Antimicrob Resist Infect Control

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Background Given the increasing incidence of Clostridioides difficile infections in Korea, there has been an increase in inappropriate testing for C. difficile, which has rendered overdiagnosis of asymptomatic colonisers common. We aimed to investigate the appropriateness of C. difficile testing and the related factors. Methods We retrospectively reviewed the medical records of patients who were admitted to a 1300-bed tertiary-care teaching hospital in Korea and were tested for C. difficile infection from September 2019 to November 2019. We performed logistic regression analysis to investigate factors related to inappropriate testing. Further, a survey was conducted on physicians to assess the knowledge and ordering patterns of C. difficile testing. Results We included 715 tests from 520 patients in the analysis. Testing was classified as hospital-onset and community-onset and subclassified as appropriate and inappropriate following an algorithmic method. Among the 715 tests, 576 (80.6%) and 139 (19.6%) tests were classified as hospital-onset and community-onset, respectively. Among the hospital-onset tests, 297 (52%) were considered inappropriate. The risk of inappropriate testing increased when C. difficile tests were conducted in the emergency room (OR 24.96; 95% CI 3.12–199.98) but decreased in intensive care units (OR 0.36, 95% CI 0.19–0.67). The survey was conducted on 61 physicians. Internal medicine physicians had significantly higher scores than non-internal medicine physicians (7.1 vs. 5.7, p = 0.001). The most frequently ordered combination of tests was toxin + glutamate dehydrogenase (47.5%), which was consistent with the ordered tests. Conclusion Almost half of the C. difficile tests were performed inappropriately. The patient being located in the emergency room and intensive care unit increased and decreased the risk of inappropriate testing, respectively. In a questionnaire survey, we showed that internal medicine physicians were more knowledgeable about C. difficile testing than non-internal medicine physicians. There is a need to implement the diagnostic stewardship for C. difficile, especially through educational interventions for emergency room and non-internal medicine physicians.

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Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with inappropriate Clostridioides difficile testing in a teaching hospital in Korea

Ham

Jung

et al. 2022

Antimicrob Resist Infect Control

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“…Age and the laboratory parameters analyzed proved to be independent risk factors for death. There are many studies demonstrating old age as a risk factor for complicated C. difficile infection outcomes 8,[11][12][13] . Patel et al 14 narrowed the age range to 70 or more years as severe CDI-risk-related and Khanna et al 4 showed that patients suffering from severely complicated infection were significantly older, with the median age of 80 years.…”

Section: Discussionmentioning

confidence: 99%

Advanced age and increased CRP concentration are independent risk factors associated with Clostridioides difficile infection mortality

Bednarska

Bursa

Podlasin³

et al. 2020

Sci Rep

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Clostridioides difficile (C.difficile) is a Gram-positive, spore-forming, toxin-producing anaerobic bacillus, which is one of the most common causes of health-care-associated infection developed mainly by elderly patients. The objective of this study was to assess mortality among the patients of the Hospital for Infectious Diseases in Warsaw related to C.difficile infection. Analysis was conducted of 1638 records reporting the medical histories of patients hospitalized for the first time due to Clostridioides difficile infection (CDI) in the Hospital for Infectious Diseases in Warsaw from 2010 to 2017. The inclusion criteria were any (principal or secondary) discharge diagnosis code for CDI according to ICD-10 and being an adult (≥ 18 years). 108 out of 1638 (7%) of the patients died. The median age in this group was 83 years. The largest number of deaths (90%) occurred in the group of patients aged 65 years or older and 81–90 years old (53% of all the deaths). In the multivariate logistic regression model relevant only to the age groups, not to sepsis—age over 80 and over 90 were independent predictors of death, increasing the risk of death by 3.4 and 1.8 times, respectively. The result of the receiver operating curve (ROC) analysis determined the age of 77 years as the threshold value, indicating the increased risk of death (AUC 0.727, standard error 0.025, 95% CI 0.678–0.776, p < 0.0001). In addition, other quantitative variables, namely CRP, creatinine and leucocytes were studied and turned out to be independent death predictors as well. The diagnosis of sepsis increased the risk of death fourfold (OR = 4.042; 95% Cl 2.4–6.7; p < 0.001). Increased inflammatory parameters, namely CRP and white blood cell count, advanced age, particularly over the age of 80, as well as a diagnosis of sepsis are independent risk factors for death and could be used as predictive markers of poor outcome in CDI.

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“…Leukocytosis (white blood cell count > 15,000 cells/mL) and acute rise in serum creatinine > 1.5 mg/dL are well established markers for severe CDI and were initially incorporated into guidelines by Society for Healthcare Epidemiology of America and the Infectious Disease Society of America in 2018 to determine which patients at risk for severe disease and should be offered more aggressive upfront therapy (i.e., vancomycin over metronidazole) [28]. In addition, older age [29,30], hypoalbuminemia [31], low hemoglobin [32], concurrent antibiotic use [31], and ICU admission [14,31] have also been previously identified as predictors of poor outcomes from CDI. Although ICU admission was part of our composite endpoint, we were careful to include only patients who were admitted to the ICU prior to CDI diagnosis as our predictor variable.…”

Section: Discussionmentioning

confidence: 99%

A Predictive Model to Identify Complicated Clostridiodes difficile Infection

Berinstein

Steiner

Rifkin

et al. 2022

Preprint

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BackgroundClostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections and may result in organ dysfunction, colectomy, and death. We recently showed that published risk scores to predict severe complications from CDI demonstrate poor performance upon external validation. We hypothesized that building and validating a model using geographically and temporally distinct cohorts would more accurately identify patients at risk for complicated CDI.MethodsWe conducted a multi-center retrospective cohort study of adult subjects diagnosed with CDI in the US. After randomly partitioning the data into training/validation set, we developed and compared three machine learning algorithms (Lasso regression, random forest, stacked ensemble models) with 10-fold cross-validation that used structured EHR data collected within 48 hours of CDI diagnosis to predict disease-related complications from CDI (intensive care unit admission, colectomy, or death attributable to CDI within 30 days of diagnosis). Model performance was assessed using area under the receiver operating curve (AUC).ResultsA total of 3,762 patients with CDI were included of which 218 (5.8%) had complications. Lasso regression, random forest, and stacked ensemble models all performed well with AUC ranging between 0.89-0.9. Variables of importance were similar across models, including albumin, bicarbonate, change in creatinine, systolic blood pressure, non-CDI-related ICU admission, and concomitant non-CDI antibiotics. Sensitivity analyses indicated that model performance was robust even when varying derivation cohort inclusion and CDI testing approach.ConclusionUsing a large heterogeneous population of patients, we have developed and validated a prediction model based on structured EHR data that accurately estimates risk for complications from CDI.Key PointsMachine learning models using structured electronic health records can be leveraged to accurately predict risk of severe complications related to Clostridiodes difficile infection, including intensive care unit admission, colectomy, and/or death.

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Risk factors for poor outcome in community-onset Clostridium difficile infection

Cited by 17 publications

References 27 publications

Prevalence of and factors associated with inappropriate Clostridioides difficile testing in a teaching hospital in Korea

Prevalence of and factors associated with inappropriate Clostridioides difficile testing in a teaching hospital in Korea

Advanced age and increased CRP concentration are independent risk factors associated with Clostridioides difficile infection mortality

A Predictive Model to Identify Complicated Clostridiodes difficile Infection

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