Outcomes and Risk Factors Associated withClostridium difficileDiarrhea in Hospitalized Adult Patients

Abstract

Background. The epidemiology of Clostridium difficile infection has changed over time. Therefore, it is essential to monitor the characteristics of patients at risk of infection and factors associated with poor prognosis. Objective. To evaluate factors associated with C. difficile infection and with poor prognosis in those with documented C. difficile colitis. Methods. A retrospective case-control study of 75 patients with documented C. difficile colitis and 75 controls with hospital-acquired diarrhea of other causes. Stepwise multiple logistic regression was used to identify factors associated with C. difficile infection among patients with hospital-acquired diarrhea. Results. Previous antibiotic treatment (odds ratio (OR), 13.3; 95% confidence interval (CI), 1.40–126.90), abdominal distension (OR, 3.85; 95% CI, 1.35–10.98), and fecal leukocytes (OR, 8.79; 95% CI, 1.41–54.61) are considered as predictors of C. difficile colitis; anorexia was negatively associated with C. difficile infection (OR, 0.15; 95% CI, 0.03–0.66). Enteral tube feeding was independently associated with a composite outcome that included in-hospital mortality, intensive care unit admission, and treatment failure (OR, 3.75; 95%CI, 1.24–11.29). Conclusions. Previous antibiotic use and presence of fecal leukocytes in patients with hospital-acquired diarrhea are associated with C. difficile colitis and enteral tube support with complications associated with C. difficile colitis.

Predictors of Mortality Among a National Cohort of Veterans With Recurrent Clostridium difficile Infection

“…Most previous work has identified the Charlson Comorbidity Index as an independent predictor of mortality; however, similar to our findings, other studies have not identified the Charlson Comorbidity Index as an independent predictor of mortality or poor outcomes [9, 42, 44]. The performance of aggregate comorbidity scores in predicting mortality is largely dependent on the underlying characteristics of the population under study [45, 46].…”

“…The diagnosis codes for cognitive dysfunction include delirium, dementia, and amnestic and other cognitive disorders [32]. To our knowledge, nutrition deficiency has not been previously identified as an independent predictor; however, conditions that may cause or be related to various nutrition deficiencies have been identified as independent predictors of mortality, such as enteral tube feeding and inflammatory bowel disease [38, 42, 43]. Although enteral tube feeding and inflammatory bowel disease are not included in the codes for nutrition deficiency, nutrition deficiency codes capture a broad spectrum of nutritional conditions, such as unspecified protein-calorie malnutrition, other malnutrition, cachexia, and vitamin deficiencies [32].…”

“…Although enteral tube feeding and inflammatory bowel disease are not included in the codes for nutrition deficiency, nutrition deficiency codes capture a broad spectrum of nutritional conditions, such as unspecified protein-calorie malnutrition, other malnutrition, cachexia, and vitamin deficiencies [32]. It is possible that some enteral tube feeding diets may lead to nutrition deficiencies in the colon and resultant disruption on the colonic microbiota [42]. Additionally, the mortality risk has consistently been shown to be higher in CDI patients with inflammatory bowel disease, a population at risk for a number of nutrition deficiencies [38, 43].…”

What Is the Role for Metronidazole in the Treatment of Clostridium difficile Infection? Results From a National Cohort Study of Veterans With Initial Mild Disease

“…We were not able to assess the resolution in CDI symptoms, so composite endpoints did not include treatment failure (continued diarrhea) which is another common poor outcome of CDI. [40] As a consensus definition for CDI-attributable mortality is not established, we measured all-cause mortality. It is possible that some of the deaths we observed were attributable, at least in part, to diseases other than CDI.…”

Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario

“…[ 30 ] Long-term enteral tube feeding with elemental diets is one of the common but relatively unrecognized risk factors for the development of Clostridium difficile colitis. [ 31 ] Contamination and batch-to-batch inconsistency are more likely with homemade or blenderized feeds than with scientific feeds. Maintaining the microbial quality of hospital-prepared blenderized feeds within the published standards of safety is difficult.…”