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]