Factors Associated With Complications of Clostridium difficile Infection in a Multicenter Prospective Cohort.
BACKGROUND
Clostridium difficile infection (CDI) is the most common cause of nosocomial infectious diarrhea and may result in severe complications including death. We conducted a prospective study to identify risk factors for complications of CDI (cCDI).


METHODS
Adult inpatients with confirmed CDI in 10 Canadian hospitals were enrolled and followed for 90 days. Potential risk factors were measured within 24 hours of diagnosis. Isolates were typed by polymerase chain reaction ribotyping. cCDI was defined as 1 or more of the following: colonic perforation, toxic megacolon, colectomy, admission to an intensive care unit for cCDI, or if CDI contributed to death within 30 days of enrollment. Risk factors for cCDI were investigated by logistic regression.


RESULTS
A total of 1380 patients were enrolled. cCDI was observed in 8% of patients. The ribotype was identified in 922 patients, of whom 52% were infected with R027. Age ≥ 80 years, heart rate >90/minute, respiratory rate >20/minute, white cell count <4 × 10(9)/L or ≥ 20 × 10(9)/L, albumin <25 g/L, blood urea nitrogen >7 mmol/L, and C-reactive protein ≥ 150 mg/L were independently associated with cCDI. A higher frequency of cCDI was observed among R027-infected patients (10.9% vs 7.2%), but the association was not significant in adjusted analysis.


CONCLUSIONS
CDI complications were associated with older age, abnormal blood tests, and abnormal vital signs. These factors, which are readily available to clinicians at the time of diagnosis, could be used for outcome prediction and risk stratification to select patients who may need closer monitoring or more aggressive therapy.
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec.
Claire Nour
CN
Abou Chakra
Mount Sinai Hospital, Toronto, Ontario.
Allison
A
McGeer
Hôpital Maisonneuve-Rosemont, Montréal, Quebec.
Annie-Claude
AC
Labbé
Sunnybrook Health Sciences Centre.
Andrew E
AE
Simor
Toronto General Hospital.
Wayne L
WL
Gold
St. Michael's Hospital.
Matthew P
MP
Muller
Toronto East General Hospital.
Jeff
J
Powis
North York General Hospital.
Kevin
K
Katz
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec.
Julian R
JR
Garneau
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec.
Louis-Charles
LC
Fortier
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec.
Jacques
J
Pépin
Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada.
Suzanne M
SM
Cadarette
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Quebec.
Louis
L
Valiquette
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003422:Critical Care; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology*; D008297:Male; D008532:Megacolon, Toxic / Q000453:epidemiology*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D021521:Ribotyping; D018570:Risk Assessment; D055815:Young Adult
Clostridium difficile; complications; mortality; ribotype 027; risk factors