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Factors associated with Complications of Clostridium difficile Infection in a Multicenter Prospective Cohort.
Clin Infect Dis. 2015 Sep 3;
Authors: Abou Chakra CN, McGeer A, Labbé AC, Simor AE, Gold WL, Muller M, Powis J, Katz K, Garneau JR, Fortier LC, Pépin J, Cadarette SM, Valiquette L
Abstract
BACKGROUND: Clostridium difficile infection (CDI) is the most common cause of nosocomial infectious diarrhea and may result in severe complications including death. We conducted a prospective study to identify risk factors for complications of CDI (cCDI).
METHODS: Adult inpatients with confirmed CDI in 10 Canadian hospitals were enrolled and followed for 90 days. Potential risk factors were measured within 24 hours of diagnosis. Isolates were typed by PCR-ribotyping. cCDI was defined as one or more of: colonic perforation, toxic megacolon, colectomy, admission to an intensive care unit for cCDI, or if CDI contributed to death within 30 days of enrollment. Risk factors for cCDI were investigated by logistic regression.
RESULTS: A total of 1380 patients were enrolled. cCDI was observed in 8% of patients. The ribotype was identified in 922 patients of whom 52% were infected with R027. Age≥80 years, heart rate >90/minute, respiratory rate>20/minute, white cell count <4x10(9)/L or ≥20x10(9)/L, albumin <25 g/L, BUN >7mmol/L, and CRP≥150 mg/L were independently associated with cCDI. A higher frequency of cCDI was observed among R027-infected patients (10.9% vs.7.2%) but the association was not significant in adjusted analysis.
CONCLUSION: CDI complications were associated with older age, abnormal blood tests and abnormal vital signs. These factors, readily available to clinicians at the time of diagnosis, could be used for outcome prediction and risk stratification to select patients who may need closer monitoring or more aggressive therapy.
PMID: 26338788 [PubMed - as supplied by publisher]