Clinical and Healthcare Burden of Multiple Recurrences of Clostridium difficile Infection.

Link to article at PubMed

Clinical and Healthcare Burden of Multiple Recurrences of Clostridium difficile Infection.

Clin Infect Dis. 2015 Nov 17;

Authors: Sheitoyan-Pesant C, Abou Chakra CN, Pépin J, Marcil-Héguy A, Nault V, Valiquette L

BACKGROUND:  Clostridium difficile infection (CDI) is associated with a high risk of recurrence (rCDI). Few studies have focused on multiple recurrences. To evaluate the potential of novel treatments targeting recurrences, we assessed the burden and severity of rCDI.
METHODS:  A retrospective cohort of adults diagnosed with CDI in a single hospital in Sherbrooke, Canada (1998-2013). An rCDI episode was defined by the reappearance of diarrhea leading to a treatment, with or without a positive toxin assay, within 14-60 days following the previous episode.
RESULTS:  We included 1527 patients. The probability of developing a first rCDI was 25% (354/1418), a second 38% (128/334), a third 29% (35/121), and a fourth or more 27% (9/33). Two or more rCDI were observed in 9% (128/1389) of all patients. The risk of a first recurrence fluctuated over time, but there was no such variation for second or further recurrences. The proportion of severe cases decreased (47% for initial episodes, 31% for first recurrences, 25% for second, 17% for third), as did the risk of complicated CDI (5.8% to 2.8%) : The severity and risk of complications of first recurrences decreased over time, while oral vancomycin was used more systemically. A hospital admission was needed for 34% (148/434) of recurrences.
CONCLUSION:  This study documented the clinical and healthcare burden of rCDI. One third of patients with rCDI needed admission, one fourth developed severe CDI and 4% developed a complication. Secular changes in the severity of recurrences could reflect variations in the predominant strain, or better management.

PMID: 26582748 [PubMed - as supplied by publisher]

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