title: Diabetes mellitus as a risk factor for recurrence of Clostridium difficile infection in the acute care hospital setting.
abstract: BACKGROUND
  Clostridium difficile-associated diarrhea (CDAD) is increasingly encountered in the acute care setting with rates of infection increasing dramatically since 2001. Reoccurring episodes are being seen with increasing frequency. The purpose of this study was to examine risk factors specifically associated with CDAD recurrence in an urban medical center.
  
  
  METHODS
  This study was conducted in a 651-bed, acute care teaching hospital in an urban community in northeastern New Jersey. We examined the medical records of subjects discharged from the institution with a diagnosis of CDAD over the 6-year period January 1, 2003, to December 31, 2008. Inclusion in the study required clinical signs and symptoms of CDAD and the presence of C difficile toxins A/B. This cohort of 247 subjects was divided into 2 groups: those who were not readmitted with CDAD within 6 months (n = 171) and those who required readmission for CDAD within 6 months of discharge from their last admission (n = 76).
  
  
  RESULTS
  Both hypoalbuminemia (odds ration [OR], 1.74, 95% confidence interval [CI]: 1.10-2.77; P = .02) and diabetes (P < .0001; OR, 3.04; 95% CI: 1.84-5.03; P < .0001) were considered as independent risk factors. After adjustment for potential confounders, hypoalbuminemia was found to be race dependent (OR, adjusted for black race: 1.62; 95% CI: 0.93-2.82; P = .09); however, diabetes was found to be a significant independent risk factor for CDAD recurrence (adjusted OR ranged from 3.79 to 5.46, minimum lower 95% confidence level: 2.01, all P values <.0001).
  
  
  CONCLUSIONS
  We have demonstrated that diabetes is an important risk factor for recurrence of CDAD. Although previous have concluded that hypoalbuminemia is associated with CDAD recurrence, our data suggest that this association may have some dependence on race or ethnicity.
authors.affiliation: Division of Gastroenterology, Department of Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ 07079, USA.
authors.forename: Rada
authors.initials: R
authors.lastname: Shakov
authors.forename: Raquel S
authors.initials: RS
authors.lastname: Salazar
authors.forename: Silvester K
authors.initials: SK
authors.lastname: Kagunye
authors.forename: Walid J
authors.initials: WJ
authors.lastname: Baddoura
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeBari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D048909:Diabetes Complications; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D014505:Urban Population