Development of a bedside scoring system for predicting a first recurrence ofClostridium difficile-associated diarrhea.
OBJECTIVE
A scoring system for identifying patients at high or low risk for recurrentClostridium difficile-associated diarrhea (CDAD) is described.


METHODS
A retrospective cohort study was performed using data on adults with CDAD admitted to a 3-hospital system from 2009 to 2014. The primary endpoint was the rate of recurrent CDAD within 60 days of clinical cure of CDAD. Risk factors for CDAD recurrence were identified, and a risk prediction tool was developed using multivariate logistic regression.


RESULTS
The CDAD cure rate in the study cohort (n= 340) was 92.3%; the 60-day recurrence rate was 16.9%. Five factors were significantly associated with high recurrence risk: presence of CDAD at admission, body temperature of >37.8 °C at admission, leukocytosis, nosocomial CDAD, and abdominal distention on CDAD presentation. From that information a risk prediction tool, the CDAD "recurrence score," was developed (1 point is assigned for each factor present, for a maximum score of 5). Validation testing of the recurrence score indicated an area under the receiver operating characteristic curve of 0.72 (95% confidence interval, 0.65-0.80). A score of ≥2 had a negative predictive value of 91%, while a score of ≥4 had a positive predictive value of 70%.


CONCLUSIONS
If externally validated in future studies, a tool for predicting the risk of recurrent CDAD using data readily available at the time of presentation could allow clinicians to identify patients at high risk for recurrence, address modifiable risk factors, and select tailored treatments to improve patient outcomes.
College of Pharmacy, Roseman University of Health Sciences, Henderson, NV. vviswesh@roseman.edu.
Velliyur
V
Viswesh
Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH.
Ana L
AL
Hincapie
Department of Pharmacy, Sharp Grossmont Hospital, La Mesa, CA.
Marie
M
Yu
Department of Pharmacy, University of Southern California Verdugo Hills Hospital, Glendale, CA.
Linda
L
Khatchatourian
Allergan plc, Jersey City, NJ.
Michael A
MA
Nowak
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003967:Diarrhea / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
D000900:Anti-Bacterial Agents
Clostridium difficile; diarrhea; recurrence; scoring system