Predictors of Recurrent Clostridioides difficile Infection

Background: Recurrence remains a major challenge in the management of Clostridioides difficile infection (CDI), with reported rates of 20-30% after an index episode. Identification of factors associated with recurrence is essential for improved risk stratification. Methods: This retrospective cohort study included 100 adult patients diagnosed with CDI. Factors associated with recurrent CDI were evaluated using univariable analyses, receiver operating characteristic analysis and backward stepwise logistic regression. Results: Eighteen patients (18%) developed recurrent CDI. Baseline demographic characteristics, comorbidity burden, clinical presentation and admission laboratory parameters were not significantly associated with recurrence. Previous hospitalization within the preceding 12 months, longer duration of antibiotic therapy and poor or partial response to initial treatment were independently associated with recurrence. Duration of antibiotic treatment showed the strongest discriminatory performance (AUC 0.712). Predictive models combining treatment response, antibiotic duration and prior hospitalization demonstrated incremental improvement in discrimination, achieving an AUC of 0.775. Associations with specific antibiotic classes did not persist after adjustment for healthcare exposure and treatment duration. Conclusions: Recurrent CDI was associated primarily with healthcare exposure and post-diagnosis treatment characteristics rather than baseline clinical or laboratory features. These findings support the relevance of integrating antibiotic burden and early treatment response into recurrence risk assessment. However, the relatively small number of recurrent cases warrants cautious interpretation of these findings.