Clinical Predictors and Risk Factors for Relapsing Clostridium difficile Infection

Abstract

BackgroundClostridium 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. MethodsThis 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. ResultsOne 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). ConclusionsFluoroquinolone 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.