title: Risk estimation for recurrent Clostridium difficile infection based on clinical factors.
abstract: BACKGROUND
  The incidence of Clostridium difficile infection (CDI) has risen dramatically during the last decade. Although patients respond well to medical therapy such as vancomycin, 20%-30% of patients treated suffer a recurrence of CDI.
  
  
  METHODS
  We developed a simple/practical scoring rule (logistic regression model) for recurrent CDI using data from 2 large phase 3 clinical trials. Seventy-seven baseline CDI factors were classified: demographics, comorbidity, medications, vital signs, laboratory tests, severity, and symptoms. Predictors with the highest discrimination in each class (using receiver operating characteristics curve) were selected. For the final model, stepwise selection was performed. Discrimination, calibration, and internal validation were used to assess the model.
  
  
  RESULTS
  The final model with a simple scoring rule was developed. It includes 4 independent risk factors that are readily available when the patient makes initial contact: age (<75 vs ≥75 years), number of unformed bowel movements during previous 24 hours (<10 vs ≥10), serum creatinine leves (<1.2 mg/dL vs ≥1.2 mg/dL) and prior episode of CDI (yes vs no). In addition, the model includes choice of treatment (vancomycin or fidaxomicin).
  
  
  CONCLUSIONS
  The prediction model for recurrence may be useful for treatment decision.
  
  
  BACKGROUND
  NCT00314951 and NCT00468728.
authors.affiliation: Mathematics and Statistics Department, Boston University.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Sylva H
authors.initials: SH
authors.lastname: Collins
authors.forename: Karol M
authors.initials: KM
authors.lastname: Pencina
authors.forename: Yin
authors.initials: Y
authors.lastname: Kean
authors.forename: Sherwood
authors.initials: S
authors.lastname: Gorbach
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D003401:Creatine / Q000097:blood; D005260:Female; D000077732:Fidaxomicin; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D012008:Recurrence; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003401:Creatine; D000077732:Fidaxomicin
keywords: CDI; Clostridium difficile infection; fidaxomicin; vancomycin