Risk factors for recurrent Clostridium difficile infection (CDI) hospitalization among hospitalized patients with an initial CDI episode: a retrospective cohort study

BMC Infectious Diseases

Erik R Dubberke²  Yan Yan²  Margaret Olsen²  Kimberly Reske²  Marya D Zilberberg¹ 

[1] EviMed Research Group, LLC, PO Box 303, Goshen, MA, USA;Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA

关键词: Recurrence;    Risk factors;    C. difficile;   

Others  :  1127659
DOI  :  10.1186/1471-2334-14-306

 received in 2014-02-03, accepted in 2014-05-26,  发布年份 2014

【 摘 要 】

Background

Recurrent Clostridium difficile infection (rCDI) is observed in up to 25% of patients with an initial CDI episode (iCDI). We assessed risk factors for rCDI among patients hospitalized with iCDI.

Methods

We performed a retrospective cohort study at Barnes-Jewish Hospital from 1/1/03 to 12/31/09. iCDI was defined as a positive toxin assay for C. difficile with no CDI in previous 60 days, and rCDI as a repeat positive toxin ≤42 days of stopping iCDI treatment. Three demographic, 13 chronic and 12 acute disease characteristics, and 21 processes of care were assessed for association with rCDI. Cox modeling identified independent risk factors for rCDI.

Results

425 (10.1%) of 4,200 patients enrolled developed rCDI. Of the eight risk factors for rCDI on multivariate analyses, the strongest three were 1) high-risk antimicrobials following completion of iCDI treatment (HR 2.95, 95% CI 2.25-3.86), 2) community-onset healthcare-associated iCDI (HR 1.80, 95% CI 1.41-2.29) and 3) fluoroquinolones after completion of iCDI treatment (HR 1.56, 95% CI 1.63-2.08). Other risk factors included gastric acid suppression, ≥2 hospitalizations within prior 60 days, age, and IV vancomycin after iCDI treatment ended.

Conclusions

The rCDI rate was 10.1%. Recognizing such modifiable risk factors as certain antimicrobial treatments and gastric acid suppression may help optimize prevention efforts.

【 授权许可】

   
2014 Zilberberg et al.; licensee BioMed Central Ltd.

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