Patients who are older, have comorbidities, and have abnormal blood tests and vital signs may be at increased risk for Clostridium difficile infection-related complications, according to a study published in Clinical Infectious Diseases. 

Louis Valiquette, MD, MSc, from the Department of Microbiology and Infectious Diseases Faculty of Medicine and Health Sciences at Université de Sherbrooke in Quebec, Canada and colleagues conducted a multicenter prospective cohort study of 1380 adults with CDI to determine what risk factors increased the odds of a patient getting complications of Clostridium difficile infections (CDI). Individual strains of C difficile were identified using polymerase chain reaction ribotyping, and the researchers reported that the R027 strain was the most common infection in participants (52%).

Logistic regression analysis linked older age, abnormal vital signs and abnormal blood tests with C difficile-infection and related complications. Most of the patients had several comorbidities, and many of the patients had taken antibiotics and acid suppression drugs. Other predictors of CDI were “leukocytosis, leukopenia, azotemia, high CRP and hypoalbuminemia.” Patients who had the R027 strain of C difficile were at increased risk for complications, with researchers reporting the statistic “nearly reaching the level of significance (P=.053).”  Researchers reported that 12% of patients died within 30 days and 22% had died within 90 days.


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The study’s limitations included the researchers’ inability to perform follow up stool tests in 25% of patients. In addition, researchers were only able to type the C difficile strain in 67% of patients. PCR assays were not available at this time, so some toxin tests may have had false positives.

David M. Aronoff, MD, of the Departments of Internal Medicine, Division of Infectious Diseases, and Microbiology and Immunology at the University of Michigan at Ann Arbor, in an editorial commentary in Clinical Infectious Diseases noted that this study is “likely to impact the development and validation of prediction rules that improve the value-based delivery of CDI care.”

References

Chakra CNA, McGeer A, Labbé AC et al. Factors associated with complications of clostridium difficile infection in a multicenter prospective cohort. Clin Infect Dis. 2015;61(12):1781-1788.

Aronoff DM. Building a better crystal ball for predicting complications of clostridium difficile infection. Clin Infect Dis. 2015;61(12):1789-1791.