Epidemiological factors influencing the development of relapsing and severe Clostridium difficile infection

Clostridium difficile infection (CDI) is currently the most frequent cause of nosocomial infectious diarrhea in adults in the developed countries. The goal of the study was to evaluate risk factors for relapsing and severe CDI in a set of patients hospitalized at the Clinic of Infectious Diseases at the University Hospital Brno.

A retrospective analysis of epidemiological, clinical and laboratory data of 281 patients with proved CDI diagnosis hospitalized in the period from 1. 1. 2007 to 31. 12. 2010.

Patient age over 65 is a risk for severe CDI (OR 2.95, p < 0.001) and extends hospitalization at the first episode of CDI by about 3.2 days on average. Patients with 2 or more comorbidities (p < 0.05) or with a history of recent hospitalization (p 0.001) are at risk for both relapsing CDI and severe CDI. The use of proton pump inhibitors may increase the number of relapses (OR 1.94, p < 0.05). If the CDI symptoms appear within 7 days of taking antibiotics, there is a greater risk of relapse (OR 2.32, p < 0.05). If the symptoms occur after a longer period, a mild or moderate course of the disease can be expected (OR 0.31, p < 0.05).

To determine the risk level for development of relapsing or severe CDI, focus on risk factors from the patients medical history and their clinical and laboratory status is appropriate at the outset of CDI patients treatment. An early intensive monitoring of vital functions and administration of aggressive treatment can reduce complications, mortality and relapses of CDI.