TY - JOUR
T1 - Risk factors for recurrent Clostridium difficile infection (CDI) hospitalization among hospitalized patients with an initial CDI episode
T2 - A retrospective cohort study
AU - Zilberberg, Marya D.
AU - Reske, Kimberly
AU - Olsen, Margaret
AU - Yan, Yan
AU - Dubberke, Erik R.
N1 - Funding Information:
This study was supported by Cubist Pharmaceuticals, Inc., San Diego, CA. The funder had no role in study design, analyses, data interpretation, or in the preparation or submission of the manuscript. Although the funder was given the opportunity to review the manuscript prior to submission, all of the editorial decisions resided with the authors. No one other than the listed authors contributed to the study.
PY - 2014/6/4
Y1 - 2014/6/4
N2 - 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.
AB - 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.
KW - C. difficile
KW - Recurrence
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=84902169955&partnerID=8YFLogxK
U2 - 10.1186/1471-2334-14-306
DO - 10.1186/1471-2334-14-306
M3 - Article
C2 - 24898123
AN - SCOPUS:84902169955
SN - 1471-2334
VL - 14
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 306
ER -