A Retrospective Analysis of Risk Factors and Therapeutic Outcomes for Clostridium difficile Infection

Abstract

Purpose: To determine the Clostridium difficile infection (CDI) recurrence rate at the Veterans Affairs Medical Center (VAMC) in Fargo, North Dakota, and to determine whether certain variables (eg, type of antibiotic, medication, chronic disease state, CDI symptom control) were predictive of CDI recurrence. Methods: Demographic information and laboratory data from 174 adult outpatients and inpatients were collected from electronic medical records between January 1997 and September 2009. In addition, information about the duration of non-CDI antibiotic therapy and the use of proton pump inhibitors, histamine H2 blockers, corticosteroids, and immunosuppressive medications within 60 days of CDI was collected. Information regarding comorbid conditions (eg, cancer, liver or renal disease, diabetes, chronic heart failure) in patients at the time of CDI was also collected. Results: Patients below the median age of 69.5 years were more likely to continue to have diarrhea after CDI treatment than patients who were older than the median age (relative risk 1.86; 95% CI, 1.06-3.26). No association was observed between previous non-CDI treatment antibiotic use, other medication use, or comorbid conditions and the recurrence of CDI. Conclusion: CDI recurrence rate at VAMC was 14%. No statistically significant association could be made between recurrence of CDI and antibiotic or medication used within 60 days of infection or with chronic disease states at the time of CDI infection. Patients younger than 69.5 years were more likely to continue to have diarrhea after CDI treatment.

Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence

“…Table 1 shows the main characteristics of the included studies. The majority of the studies were conducted in North America (n = 26) [13,14,[16][17][18][19][20]23,[25][26][27]31,33,34,38,40,41,[43][44][45][46][47][48][49][50][51], whilst 7 were conducted in Europe (mainly in the UK) [21,22,[28][29][30]32,35]. One more study included patients from North America and the UK [15], four from Asia (South Korea and Taiwan) [36,37,39,42] and one from Argentina [24].…”

“…Six studies were funded by pharmaceutical companies [14][15][16][17][18]21], 18 received grants from non-profit organisations and institutions or universities [13,19,22,24,25,27,30,33,34,36,40-45, 49,51] and 4 received funds from both [20,23,28,38]; no data were available for the remaining 11 studies [26,29,31,32,35,37,39,[46][47][48]50]. In 5 of the 18 non-profit-funded studies the authors reported having received grants from pharmaceutical companies [19,25,27,34,49], as did 1 of the 11 studies for which no funding was reported [31].…”

“…In 5 of the 18 non-profit-funded studies the authors reported having received grants from pharmaceutical companies [19,25,27,34,49], as did 1 of the 11 studies for which no funding was reported [31]. In 14 studies the authors reported no conflicts of interest [13,22,24,29,30,32,33,40,41,[43][44][45]48,50], whilst in the remaining 9 studies no data regarding conflict of interest were reported [26,[35][36][37]39,42,46,47,51].…”

“…The follow-up period was up to 1 month in 6 studies [16,18,19,28,35,48], 1-2 months in 12 studies [13][14][15]20,22,24,26,31,36,37,47,49] and 2-3 months in 12 studies [17,23,27,[32][33][34][38][39][40]42,43,51]; 2 studies had a 6-month follow-up period [41,50]. The length of the follow-up period was not reported in seven studies [21,25,29,30,[44][45][46].…”

“…The mean or median age was >65 years in 22 studies [13][14][15]18,20,22,25,28,30,31,[33][34][35]38,[41][42][43][47][48][49][50][51] and it was ≤65 years in 15 studies [16,17,19,21,23,26,29,32,36,37,39,40,[44][45][46], whilst 2 of them provided no data regarding age [24,27]. Three studies enrolled only children [29,45,46], two enrolled both children and adults [21,49] and seven did not discriminate between children and adults [24,[31][32][33][34]41,...…”