Risk Factors for RecurrentClostridium difficileInfection

Abstract

Background/Aims: Clostridium difficile infection (CDI) is a common nosocomial infection associated with substantial morbidity, mortality and increased medical care costs. Although most patients initially respond to therapy, with either metronidazole or vancomycin, about 15-20% of patients experience recurrence. The aim of this study was to analyze the risk factors related to recurrent CDI (RCDI). Methods: We retrospectively reviewed data, from patients diagnosed with CDI during admission at a university hospital between January 2000 and December 2006, for comparison with data from RCDI patients. Results: Among a total of 294 CDI patients, 32 (10.8%) had experienced RCDI. Risk factors for RCDI included anemia, congestive heart failure, respiratory infection, time between admission and CDI diagnosis, duration of antibiotic therapy prior to CDI diagnosis, tube feeding, and gastrointestinal endoscopy. Multivariate analysis revealed that tube feeding was associated with recurrence (odds ratio, 3.65; 95% confidence interval, 1.38-9.65; P=0.009). Conclusions: Patients who received tube feeding were at increased risk of RCDI. Targeting these patients for preventive strategies may contribute to a reduction in the incidence of RCDI.

Long-Term Clinical Outcome ofClostridium difficileInfection in Hospitalized Patients: A Single Center Study

“…In addition, other known CDI recurrence trigger conditions include: (1) patients older than 65 years of age, (2) continuous antibiotic usage, (3) failure to provide proper treatment, and (4) suppressed patient immune systems 32,33,34,35. However, re-infection with new strains is believed to be mainly responsible for CDI recurrence (48-75%) 14,34,35,36. In this respect, it is meaningful that nasogastric tube insertion increases the risk of CDI up to 9-fold as manipulation of contaminated instruments can transfer C. difficile strains from hospital environments 37.…”

“…Basically, unnecessary use of broad-spectrum antibiotics should be avoided and more emphasis should be placed on hygiene management such as washing hands. In addition, more active preventive measurements should be discussed; for instance, an aseptic method for nasogastric tube insertion might be worthwhile to consider for patients with a history of CDI 14. Lastly, additional investigations are needed to distinguish if recurrence was caused by the same strain or re-infection by other strains by analyzing samples from patients with chronic recurrence.…”

Epidemiology of Clostridium difficile infection in Asia

“…Risk factors for recurrent CDI included antibiotic therapy, anaemia, and tube feeding in one study [23], while another found proton pump inhibitor (PPI) use alone was associated with recurrent disease [24]. One study found that the proportion of community-acquired CDI (CA-CDI) among all CDI cases within a Busan hospital was 7.1% [25], while another reported that 59.4% of cases of CDI presenting at the emergency department of a Seoul hospital were community-acquired [26].…”

Biological characteristics associated with virulence in Clostridioides difficile ribotype 002 in Hong Kong

“…These suggested that the epidemiology of C. difficile was not only caused by one or a few hypervirulent ribotypes but also included a diversity of strains in causing the infection. In Asia, hypervirulent ribotype 027 strain only occurred sporadically, with the most prevalent ribotypes being 002, 017, 018, 014 and 012 [19,[35][36][37][38][39][40][41]. In Hong Kong, the rising incidence and disease burden of CDI have been reported, with the most common ribotypes being 002 (22.8%), 012 (14.1%), 014 (14.1%) and 046 (13.0%) [42].…”