title: Influence of cohorting patients with Clostridium difficile infection on risk of symptomatic recurrence.
abstract: BACKGROUND
  Cohorting of patients with Clostridium difficile infection (CDI) is recommended when single side-rooms are unavailable. Although patients may remain infectious after cessation of diarrhoea, continued cohorting may place them at increased risk of reinfection.
  
  
  OBJECTIVE
  To identify risk factors for CDI recurrence and to determine whether cohorting of patients is associated with increased risk of recurrence.
  
  
  METHODS
  Data describing patient demographics, comorbidity, CDI severity and treatment were collected for 248 CDI patients at our hospital between October 2008 and June 2011. The primary outcome was symptomatic recurrence within 30 days of diagnosis.
  
  
  RESULTS
  One hundred and thirty-eight (55.6%) CDI patients were admitted to the cohort ward. These patients were more likely to have severe CDI (odds ratio: 1.95; 95% confidence interval: 1.10-3.46; P = 0.022) and receive vancomycin (1.59; 0.94-2.68; P = 0.083) than patients who were not cohorted. Twenty-six patients (10.5%) suffered recurrence (21 cohorted and five not cohorted). Urinary infection on admission (5.16; 2.10-12.64; P < 0.001), cohorting (3.77; 1.37-10.35; P = 0.01) and concomitant antibiotics (2.07; 0.91-4.72; P = 0.083) were associated with increased risk of recurrence. On multivariate analysis, cohorting (3.94; 1.23-12.65; P = 0.021) and urinary infection (4.27; 1.62-11.24; P = 0.003) were significant predictors of recurrence.
  
  
  CONCLUSIONS
  Patients admitted to a C. difficile cohort ward may be at increased risk of recurrence because they are at increased risk of reinfection. Hospitals using cohort wards to control C. difficile should manage patient flow through the cohort to minimize this risk.
authors.affiliation: Pathogen Host Interaction Group, Division of Clinical Medicine, Brighton & Sussex Medical School, Brighton, UK.
authors.forename: J
authors.initials: J
authors.lastname: Islam
authors.forename: E
authors.initials: E
authors.lastname: Cheek
authors.forename: V
authors.initials: V
authors.lastname: Navani
authors.forename: C
authors.initials: C
authors.lastname: Rajkumar
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: M J
authors.initials: MJ
authors.lastname: Llewelyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention
keywords: Clostridium difficile infection (CDI); Cohort ward; Recurrence