Recurrent Clostridium difficile Infection in Patients With Chronic Kidney Disease

Abstract

Introduction: To evaluate the impact of chronic kidney disease (CKD) on recurrent Clostridium difficile infection (RCDI) in hospitalized patients. Methods: This is a retrospective case control study of 2,020 patients admitted for >48 hours to our institution between 1/2007 and 11/2013 with Clostridium difficile infection (CDI). CDI was defined as >3 episodes of loose stools in <24 h with a positive CD stool toxin assay. Recurrent CDI (RCDI) defined as readmission for recurrent diarrhea with second positive stool test 15-90 days following complete resolution of previous diarrheal episode and cessation of CDI treatment. Computerized medical records to investigate demographics, laboratory blood work, Carlson comorbidity index, and medication used. Patients were divided accordingly into stages 1, 2, 3, 4 and 5 CKD by measuring glomerular filtration rate (GFR). Univariate predictors of RCDI and multiple logistic regression to assess whether CKD is an independent risk factor for developing CD, controlling for age, serum albumin, modified CCI, PPI, antibiotics, and CDI treatment. Results: Two thousand six patients had complete data. RCDI was identified in 209 patients <90 days and 154 patients >90 days. One thousand forty-five patients had normal kidney function, 537 had CKD stage 3, 261 patients had stage 4 CKD, and 163 had stage 5 CKD. Recurrence rate was 11% in normal kidney function patients, 8% in CKD 3, 8% in CKD 4, and 17% in CKD 5 patients. In univariate and multivariate model CKD was significantly associated with RCDI (p=0.039). In univariate and multivariate model CKD was significantly associated with RCDI (p=0.039). In univariate and multivariate model CKD was significantly associated with RCDI (p=0.039). Conclusion: CKD, PPIs use, high CCI score, and the type of treatment used for previous CDI are significantly associated with RCDI. CKD is an independent predictor of RCDI in our study.Table