title: Response failure to the treatment of Clostridium difficile infection and its impact on 30-day mortality.
abstract: OBJECTIVE
  Few data are available on response failure and hospital mortality. This study aimed to evaluate the association between response failure to the treatment of CDI and 30-day mortality.
  
  
  METHODS
  Medical records of patients diagnosed with CDI between March 2005 and March 2010 were reviewed. CDI diagnosis was considered in patients with diarrhea when the stool toxins assay was positive or pseudomembranous colitis (PMC) was confirmed by endoscopy. If there were no symptomatic improvements during 10 days of treatment, the case was regarded as response failure. Patients were stratified into a mild or severe disease group based on clinical criteria.
  
  
  RESULTS
  Among 536 subjects (age 64±14.12, mild 266, severe 270), 26 (4.9%) showed response failure, which occurred more frequently in the severe disease than mild disease group. Forty-eight (9%) patients died within 1 month and mortality rate in the failure group was higher than in the response group (42.3% vs. 7.3%, p<0.001). Malignancy, albumin <2.5 mg/dL, WBC >15,000 cells/mm3, ICU admission and response failure were independent risk factors associated with 30-day mortality after CDI.
  
  
  CONCLUSIONS
  Response failure to the treatment negatively affects a patients’ survival within 30 days after CDI.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Eun Soo
authors.initials: ES
authors.lastname: Kim
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Park
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.forename: Byoung Kuk
authors.initials: BK
authors.lastname: Jang
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Chung
authors.forename: Jae Seok
authors.initials: JS
authors.lastname: Hwang
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Park
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016360:Clostridioides difficile / Q000472:pathogenicity*; D016099:Endoscopy, Gastrointestinal; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005243:Feces / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents