Clinical predictors and risk factors for relapsing Clostridium difficile infection.
BACKGROUND
Clostridium difficile infection (CDI) is a common cause of morbidity among hospitalized patients. Multiple factors have been associated with primary CDI, but risk factors for CDI relapses are less well described.


METHODS
This was a retrospective cohort study of patients with CDI over a 15-month period. We compared patients with relapsing and nonrelapsing CDI, including risk factors associated with primary CDI and other variables hypothesized to be associated with relapsing CDI and 90-day mortality. Multivariable logistic regression models were created to examine risk factors for relapse and 90-day mortality.


RESULTS
One hundred twenty-nine consecutive patients with CDI were included; 38 (29%) had relapsing CDI. Factors associated with relapsing CDI included fluoroquinolone use (71% versus 49%, P = 0.04) and incidence of stroke (29% versus 12%, P = 0.02). In a regression model, use of a fluoroquinolone was associated with relapsing CDI (OR = 2.52, 95% CI = 1.11-5.72). Factors associated with 90-day mortality included higher Charlson comorbidity index score (4.34 +/- 1.71 versus 3.42 +/- 2.08, P = 0.02), severe CDI (58% versus 32%, P = 0.01), and the use of piperacillin/tazobactam (45% versus 23%, P = 0.03) or meropenem (10% versus 1%, P = 0.04). In the regression analysis, 90-day mortality was associated with severe CDI (OR = 1.76; 95% CI = 1.19-2.59).


CONCLUSIONS
Fluoroquinolone use and prior stroke are associated with an increased risk of relapsing CDI. Relapsing CDI and severe CDI are both associated with increased 90-day mortality.
Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX 78229, USA. josecadenaz@yahoo.com
Jose
J
Cadena
George R
GR
Thompson
Jan E
JE
Patterson
Brandy
B
Nakashima
Aaron
A
Owens
Kelly
K
Echevarria
Eric M
EM
Mortensen
D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000175:diagnosis
D024841:Fluoroquinolones