title: Low vitamin D level and impact on severity and recurrence of Clostridium difficile infections.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) has recently markedly increased, incurring greater health care-associated costs and hospitalizations especially in vitamin D deficient patients. Accordingly, the aim of this study was to evaluate the relationship between low vitamin D levels and the severity and recurrence of CDI.
  
  
  METHODS
  A retrospective case-control study evaluated patients hospitalized between 2007 and 2013 with CDI and a positive C. difficile toxin assay. Severe complicated CDI was defined based on (1) laboratory or radiological criteria correlated clinically and (2) sepsis requiring intensive care unit admission. Recurrent CDI (RCDI) was defined as a new episode of diarrhea occurring within 90 days of resolution of the initial episode for at least 10 days after discontinuing therapy and confirmed by positive stool C. difficile toxin assay or polymerase chain reaction. Patients were divided into 4 groups based on vitamin D level (ng/mL): severely deficient (<10), insufficient (10-19.9), predeficient (20-29.9), and control group (≥30).
  
  
  RESULTS
  Two hundred seventy-one patients were diagnosed with CDI, of which 48 had RCDI distributed as 5 (12.5%), 15 (16.1%), 10 (15.6%), and 13 (17.5%) patients in each of the aforementioned groups, respectively (P=0.55). Severe complicated CDI was identified in 7 (17.5%), 17 (18.2%), 9 (14%), and 3 (4%) patients, respectively (P=0.04). Thirty-day mortality was 1 of 40, 1 of 93, 2 of 64, and 2 of 74 patients, respectively (P=0.43).
  
  
  CONCLUSIONS
  Normal vitamin D level has a protective effect against severe CDI, and low vitamin D is associated with greater severity of CDI but not with an increased risk of RCDI or 30-day mortality.
authors.affiliation: From the *Department of Medicine, Akron General Medical Center, Akron; †Department Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland; ‡Division of Infectious Diseases, Department of Medicine, Case Western Reserve University; §Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland; ∥Division of Gastroenterology and Hepatology, East Carolina University, Greenville; ¶Division of Infectious Diseases, Akron General Medical Center, Akron; and #Department of Medicine, Northeast Ohio Medical University, Rootstown, OH.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelfatah
authors.forename: Rabih
authors.initials: R
authors.lastname: Nayfe
authors.forename: Bahar
authors.initials: B
authors.lastname: Moftakhar
authors.forename: Ala
authors.initials: A
authors.lastname: Nijim
authors.forename: Maysaa
authors.initials: M
authors.lastname: El Zoghbi
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
authors.forename: Hossam
authors.initials: H
authors.lastname: Kandil
authors.forename: Richard R
authors.initials: RR
authors.lastname: Watkins
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000502:physiology*; D003015:Clostridium Infections / Q000097:blood* / Q000382:microbiology* / Q000401:mortality; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D014807:Vitamin D / Q000097:blood*
chemical_list: D014807:Vitamin D