Risk factors for poor outcome in community-onset Clostridium difficile infection

Eunyoung Lee,Wan Beom Park,Doran Yoon,Sang Won Park,Ji Hwan Bang,Pyoeng Gyun Choe,Kyoung-Ho Song,Nam Joong Kim,Ji Yun Bae,Eu Suk Kim,Hong Bin Kim,Joo-Hee Hwang,Myoung-Don Oh

doi:10.1186/s13756-018-0365-6

Abstract

BackgroundA substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI.MethodsWe performed a retrospective review of all inpatients with CDI, in a 1300-bed tertiary-care hospital in Korea, from 2008 through 2015. CO-CDI was defined as CDI occurring within 48 h of admission. Poor outcome was defined as follows: 1) all-cause 30-day mortality, 2) in-hospital mortality, or 3) surgery due to CDI.ResultsOf a total 1256 CDIs occurring over 8 years, 152 (12.1%) cases were classified as CO-CDI and 23 (15.1%) had a poor outcome, including 22 (14.5%) cases of mortality and 2 (1.3%) cases of surgery. Patients with a poor outcome had a higher mean age than those without a poor outcome (75.8 vs. 69.6 years, p = 0.03). The proportion of men and prior proton pump inhibitor (PPI) use were significantly higher in the poor outcome group (65.2% vs. 41.9%, p = 0.04; 39.1% vs. 17.6%, p = 0.02, respectively). Multivariate binary logistic model showed that PPI use and anemia (hemoglobin < 10 g/dL) at presentation were significantly associated with a poor outcome (adjusted odds ratio [aOR], 3.76; 95% confidence interval [95CI], 1.26–11.21, aOR, 4.67; 95CI, 1.52–14.34, respectively).ConclusionsClinicians should not only be aware of the possibility of CDI in the community setting but also pay more attention to PPI-using elderly patients with anemia in consideration of a poor outcome.

Highlights

A substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality
Clostridium difficile is an anaerobic spore-forming bacterium that is resistant to gastric acid; it can stay in the intestinal tract and proliferate when the normal gut flora is disrupted under specific circumstances such as antibiotic agent usage
In agreement with a previous report by Khanna et al [10] which showed that CO-CDI in relatively young patients may follow a milder clinical course, we demonstrated that older patients with CO-CDI still had a higher risk of a poor outcome

Summary

Introduction

A substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI. C. difficile infection (CDI) has been identified as a major cause of nosocomial diarrhea. The incidence of CDI has been increasing over the last 10 to 20 years, and several outbreaks of CDI have occurred globally [1]. In the United States, costs associated with CDI exceed $1.1 billion per year, even with conservative estimates [2]. Recent studies have reported that a substantial portion of CDI occurs in the community and its incidence has been increasing [3]. Only 24.2% of CDI occurred during hospitalization in the United States [4]. An Australian study reported that community-onset CDI (CO-CDI) accounted for 29% of CDI [5]; in a Taiwanese report, CO-CDI accounted of 15% CDI when the percentage of community-acquired CDI

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