Clinical predictors and risk factors for relapsing clostridium difficile infection

Jose Cadena, George Richard Thompson, Jan E. Patterson, Brandy Nakashima, Aaron Owens, Kelly Echevarria, Eric M. Mortensen

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Clostridium difficile infection (CDI) is a common cause of morbidity among hospitalized patients. Multiple factors have been associated with primary CDI, but risk factors for CDI relapses are less well described. Methods: This was a retrospective cohort study of patients with CDI over a 15-month period. We compared patients with relapsing and nonrelapsing CDI, including risk factors associated with primary CDI and other variables hypothesized to be associated with relapsing CDI and 90-day mortality. Multivariable logistic regression models were created to examine risk factors for relapse and 90-day mortality. Results: One hundred twenty-nine consecutive patients with CDI were included; 38 (29%) had relapsing CDI. Factors associated with relapsing CDI included fluoroquinolone use (71% versus 49%, P = 0.04) and incidence of stroke (29% versus 12%, P = 0.02). In a regression model, use of a fluoroquinolone was associated with relapsing CDI (OR = 2.52, 95% CI = 1.11-5.72). Factors associated with 90-day mortality included higher Charlson comorbidity index score (4.34 ± 1.71 versus 3.42 ± 2.08, P = 0.02), severe CDI (58% versus 32%, P = 0.01), and the use of piperacillin/tazobactam (45% versus 23%, P = 0.03) or meropenem (10% versus 1%, P = 0.04). In the regression analysis, 90-day mortality was associated with severe CDI (OR = 1.76; 95% CI = 1.19-2.59). CONCLUSION: Fluoroquinolone use and prior stroke are associated with an increased risk of relapsing CDI. Relapsing CDI and severe CDI are both associated with increased 90-day mortality.

Original languageEnglish (US)
Pages (from-to)350-355
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume339
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Clostridium Infections
Clostridium difficile
Fluoroquinolones
Mortality
meropenem
Logistic Models
Stroke
Recurrence

Keywords

  • Antibiotic-associated diarrhea
  • CDI
  • Clostridium difficile
  • Mortality
  • Relapse

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical predictors and risk factors for relapsing clostridium difficile infection. / Cadena, Jose; Thompson, George Richard; Patterson, Jan E.; Nakashima, Brandy; Owens, Aaron; Echevarria, Kelly; Mortensen, Eric M.

In: American Journal of the Medical Sciences, Vol. 339, No. 4, 04.2010, p. 350-355.

Research output: Contribution to journalArticle

Cadena, J, Thompson, GR, Patterson, JE, Nakashima, B, Owens, A, Echevarria, K & Mortensen, EM 2010, 'Clinical predictors and risk factors for relapsing clostridium difficile infection', American Journal of the Medical Sciences, vol. 339, no. 4, pp. 350-355. https://doi.org/10.1097/MAJ.0b013e3181d3cdaa
Cadena, Jose ; Thompson, George Richard ; Patterson, Jan E. ; Nakashima, Brandy ; Owens, Aaron ; Echevarria, Kelly ; Mortensen, Eric M. / Clinical predictors and risk factors for relapsing clostridium difficile infection. In: American Journal of the Medical Sciences. 2010 ; Vol. 339, No. 4. pp. 350-355.
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T1 - Clinical predictors and risk factors for relapsing clostridium difficile infection

AU - Cadena, Jose

AU - Thompson, George Richard

AU - Patterson, Jan E.

AU - Nakashima, Brandy

AU - Owens, Aaron

AU - Echevarria, Kelly

AU - Mortensen, Eric M.

PY - 2010/4

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N2 - Background: Clostridium difficile infection (CDI) is a common cause of morbidity among hospitalized patients. Multiple factors have been associated with primary CDI, but risk factors for CDI relapses are less well described. Methods: This was a retrospective cohort study of patients with CDI over a 15-month period. We compared patients with relapsing and nonrelapsing CDI, including risk factors associated with primary CDI and other variables hypothesized to be associated with relapsing CDI and 90-day mortality. Multivariable logistic regression models were created to examine risk factors for relapse and 90-day mortality. Results: One hundred twenty-nine consecutive patients with CDI were included; 38 (29%) had relapsing CDI. Factors associated with relapsing CDI included fluoroquinolone use (71% versus 49%, P = 0.04) and incidence of stroke (29% versus 12%, P = 0.02). In a regression model, use of a fluoroquinolone was associated with relapsing CDI (OR = 2.52, 95% CI = 1.11-5.72). Factors associated with 90-day mortality included higher Charlson comorbidity index score (4.34 ± 1.71 versus 3.42 ± 2.08, P = 0.02), severe CDI (58% versus 32%, P = 0.01), and the use of piperacillin/tazobactam (45% versus 23%, P = 0.03) or meropenem (10% versus 1%, P = 0.04). In the regression analysis, 90-day mortality was associated with severe CDI (OR = 1.76; 95% CI = 1.19-2.59). CONCLUSION: Fluoroquinolone use and prior stroke are associated with an increased risk of relapsing CDI. Relapsing CDI and severe CDI are both associated with increased 90-day mortality.

AB - Background: Clostridium difficile infection (CDI) is a common cause of morbidity among hospitalized patients. Multiple factors have been associated with primary CDI, but risk factors for CDI relapses are less well described. Methods: This was a retrospective cohort study of patients with CDI over a 15-month period. We compared patients with relapsing and nonrelapsing CDI, including risk factors associated with primary CDI and other variables hypothesized to be associated with relapsing CDI and 90-day mortality. Multivariable logistic regression models were created to examine risk factors for relapse and 90-day mortality. Results: One hundred twenty-nine consecutive patients with CDI were included; 38 (29%) had relapsing CDI. Factors associated with relapsing CDI included fluoroquinolone use (71% versus 49%, P = 0.04) and incidence of stroke (29% versus 12%, P = 0.02). In a regression model, use of a fluoroquinolone was associated with relapsing CDI (OR = 2.52, 95% CI = 1.11-5.72). Factors associated with 90-day mortality included higher Charlson comorbidity index score (4.34 ± 1.71 versus 3.42 ± 2.08, P = 0.02), severe CDI (58% versus 32%, P = 0.01), and the use of piperacillin/tazobactam (45% versus 23%, P = 0.03) or meropenem (10% versus 1%, P = 0.04). In the regression analysis, 90-day mortality was associated with severe CDI (OR = 1.76; 95% CI = 1.19-2.59). CONCLUSION: Fluoroquinolone use and prior stroke are associated with an increased risk of relapsing CDI. Relapsing CDI and severe CDI are both associated with increased 90-day mortality.

KW - Antibiotic-associated diarrhea

KW - CDI

KW - Clostridium difficile

KW - Mortality

KW - Relapse

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