title: Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis.
abstract: Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95% CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.
authors: Leiden University Medical Center, Leiden, The Netherlands.
authors: Martijn P
authors: MP
authors: Bauer
authors: Marjolein P M
authors: MP
authors: Hensgens
authors: Mark A
authors: MA
authors: Miller
authors: Dale N
authors: DN
authors: Gerding
authors: Mark H
authors: MH
authors: Wilcox
authors: Adam P
authors: AP
authors: Dale
authors: Warren N
authors: WN
authors: Fawley
authors: Ed J
authors: EJ
authors: Kuijper
authors: Sherwood L
authors: SL
authors: Gorbach
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D016001:Confidence Intervals; D003401:Creatine / Q000032:analysis; D005334:Fever / Q000150:complications; D000077732:Fidaxomicin; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000209:etiology* / Q000382:microbiology; D016017:Odds Ratio; D011379:Prognosis; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D051437:Renal Insufficiency / Q000209:etiology* / Q000382:microbiology; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003401:Creatine; D000077732:Fidaxomicin