title: Risk factors associated with complications and mortality in patients with Clostridium difficile infection.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) has increased in frequency and severity over the past decade. An understanding of the modifiable risk factors for disease severity has considerable clinical applicability.
  
  
  METHODS
  We performed a retrospective case review of 485 cases in patients aged 1-99 years at the Naval Medical Center San Diego from November 2004 through December 2008. We compared potential risk factors for association with complications (megacolon, surgery, intensive care unit stay, and death) or mortality alone with use of univariable and multivariable logistic regression modeling.
  
  
  RESULTS
  Forty-seven patients (9.8%) developed ≥1 complication, and 23 (4.7%) died. We found independent associations between complications and acid suppression (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.79), admission for CDI (OR, 4.14; 95% CI, 2.17-7.92), older age (≥80 years; OR, 3.14; 95% CI, 1.46-6.73), and corticosteroid use (OR, 2.09; 95% CI, 1.01-4.35). Age ≥80 years (OR, 5.51; 95% CI, 2.25-13.49) and acid suppression (OR, 4.74; 95% CI, 1.57-14.37) were associated with increased odds of death.
  
  
  CONCLUSIONS
  Data published elsewhere have suggested that acid suppression therapy is a risk factor for CDI acquisition and relapse. These findings suggest an additional role in increased severity of disease, including mortality, and merit further study.
authors: San Diego State University Graduate School of Public Health, San Diego, California, USA.
authors: Rosemary H
authors: RH
authors: Morrison
authors: Natalie S
authors: NS
authors: Hall
authors: Mina
authors: M
authors: Said
authors: Tamar
authors: T
authors: Rice
authors: Harold
authors: H
authors: Groff
authors: Stephanie K
authors: SK
authors: Brodine
authors: Donald
authors: D
authors: Slymen
authors: Edith R
authors: ER
authors: Lederman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification* / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult