title: Predictors of severe outcomes in patients with Clostridium difficile infection from a Hispanic population.
abstract: BACKGROUND
  Factors associated with complicated Clostridium difficile infection (CDI) may vary among populations, and predictors of severe outcomes in CDI have not been studied in Hispanic patients. The aim of this study was to identify factors associated with a higher risk of colectomy, all-cause mortality, and CDI-associated mortality in a Hispanic population.
  
  
  METHODS
  We performed a retrospective study of all hospitalized patients with a diagnosis of CDI between January 1, 2011 and September 30, 2015 in a 450-bed teaching hospital in Monterrey, northeast Mexico. Three main outcomes were defined: fulminant colitis with subsequent colectomy, all-cause mortality within 30 days of diagnosis, and CDI-attributable mortality.
  
  
  RESULTS
  Of 261 patients with diarrhea, 176 were diagnosed with CDI. For colectomy, Charlson comorbidity index, ICU stay and mechanical ventilation prior to CDI diagnosis, days with diarrhea prior to treatment, total days of hospital stay and days after CDI diagnosis, elevated ATLAS score, days of diarrhea post CDI treatment, and treatment failure significantly predicted the necessity of surgical treatment with colectomy.
  
  
  CONCLUSIONS
  Treatment failure, persistent diarrhea, and a high ATLAS score were identified as risk factors for severe outcomes of CDI. A low albumin concentration and high creatinine were associated with higher overall mortality.
authors.affiliation: Servicio de Infectología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
authors.forename: Laura
authors.initials: L
authors.lastname: Paláu-Dávila
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
authors.forename: Elvira
authors.initials: E
authors.lastname: Garza-González
authors.affiliation: Servicio de Infectología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
authors.forename: Eva María
authors.initials: EM
authors.lastname: Gutiérrez-Delgado
authors.affiliation: Servicio de Infectología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico. acamacho_md@yahoo.com.|Coordinación de Epidemiología Hospitalaria, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico. acamacho_md@yahoo.com.
authors.forename: Adrián
authors.initials: A
authors.lastname: Camacho-Ortiz
mesh_terms: D000418:Albumins / Q000172:deficiency; D016360:Clostridioides difficile; D003015:Clostridium Infections; D003082:Colectomy; D003092:Colitis / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D003967:Diarrhea; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors
chemical_list: D000418:Albumins; D003404:Creatinine
keywords: Clostridium difficile infection; Outcome; Predictors; Risk factors