Evaluation of a bedside scoring system for predicting clinical cure and recurrence of Clostridium difficile infections.
OBJECTIVE
The accuracy of a bedside scoring system, ATLAS, for predicting clinical cure and recurrence of Clostridium difficile infections (CDIs) was evaluated.


METHODS
A single-center retrospective medical record review was performed for symptomatic adult patients with stool assay-diagnosed CDI treated with metronidazole or vancomycin or both. Multiple logistic regression analysis was performed to assess the potential association of the ATLAS score and other potential factors on achieving cure and 90-day CDI recurrence. ATLAS scores were calculated, and risk factors for severe CDI, severe-complicated CDI, decreased cure rates, and recurrence were recorded.


RESULTS
Data from 245 adult patients were assessed. ATLAS scores showed a significant inverse association with the cure rate (p = 0.009) but not with the 90-day recurrence rate (p = 0.901). The only ATLAS component to be independently associated (inversely) with cure was the concomitant use of antibiotics (p = 0.022). Metronidazole was initiated in 97% of patients, with 32% switching to oral vancomycin. Longer courses of vancomycin were associated with a higher cure rate (p = 0.0009) but not with recurrence (p = 0.170). Complicated cases were less likely to be cured (p = 0.027) and more likely to recur within 90 days (p = 0.002). Antibiotics continued after CDI treatment was associated with recurrence (p = 0.055).


CONCLUSIONS
A low ATLAS score was found to correlate with higher cure rates in patients with CDI receiving metronidazole, oral vancomycin, or both. However, the score could not predict CDI recurrence.
Shauna M. Jacobson, Pharm.D., BCPS, is Infectious Diseases Clinical Specialist, Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, Orlando, FL. Douglas Slain, Pharm.D., BCPS, FASHP, is Associate Professor, Infectious Diseases Clinical Specialist, Department of Clinical Pharmacy, School of Pharmacy, and Infectious Diseases Clinical Specialist, Section of Infectious Diseases, School of Medicine, West Virginia University, Morgantown.
Shauna M
SM
Jacobson
Shauna M. Jacobson, Pharm.D., BCPS, is Infectious Diseases Clinical Specialist, Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, Orlando, FL. Douglas Slain, Pharm.D., BCPS, FASHP, is Associate Professor, Infectious Diseases Clinical Specialist, Department of Clinical Pharmacy, School of Pharmacy, and Infectious Diseases Clinical Specialist, Section of Infectious Diseases, School of Medicine, West Virginia University, Morgantown. dslain@hsc.wvu.edu.
Douglas
D
Slain
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin