Risk Factors for Relapse and Mortality of Clostridium Difficile-Associated Diarrhea

Bogdan Arsic; Momcilo Pavlovic; Karolina Berenji

doi:10.3889/oamjms.2014.040

Authors

Bogdan Arsic General Hospital Subotica - Infectious Disease Department, Subotica
Momcilo Pavlovic College of Vocational Studies, Subotica
Karolina Berenji Public Health Institute, Subotica

DOI:

https://doi.org/10.3889/oamjms.2014.040

Keywords:

Clostridium difficile, Diarrhea, Nosocomial infection, Relapse, Mortality.

Abstract

AIM: The aim of the present paper was to identify prognostic factors for relapse and mortality in patients with hospital-acquired infections caused by Clostridium difficile.

MATERIAL AND METHODS: This study included 133 patients with healthcare facility-associated disease caused by C. difficile. The medical records of all patients with their clinical history and laboratory data were analyzed.

RESULTS: Patients with one onset of disease were 105 (78.9%), 28 (21.1%) experienced a relapse and seven (5.2%) patients not survived infection. The average age in our patients was over 65 years (64.5 years in the survived patients and 78.8 in patient who died, p = 0.01). All of patients had received antibiotic treatment (cephalosporins â€“ 83.4%, aminoglycosides â€“ 21.5% and penicillins â€“ 20.3%) and 40.6% of patients received acid-reducing therapy. There was no difference between patients with one onset of disease/patients with relaps; and survived/died in number of administered antibiotics, duration of administration, administration of acid-reducing treatment or length of hospital stay (p > 0.05). CRP levels were significantly higher in the group of patients who died compared with recovered (p < 0.001).Â

CONCLUSION:Â C. difficile-associated diarrhea is a common nosocomial disease with high relapse, and significant mortality rate particularly in the elderly.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

McFarland LV, Stamm WE. Review of Clostridium difficile associated diseases. Am J Infect Control. 1986;14(3):99-109. DOI: https://doi.org/10.1016/0196-6553(86)90018-0

Savidge TC, Pan WH, Newman P, O'brien M, Anton PM, Pothoulakis C. Clostridium difficile toxin B is an inflammatory enterotoxin in human intestine. Gastroenterology. 2003;125(2):413-20. DOI: https://doi.org/10.1016/S0016-5085(03)00902-8

Barbut F, Petit JC. Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect. 2001;7(8):405âˆ’10. DOI: https://doi.org/10.1046/j.1198-743x.2001.00289.x

Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-55. DOI: https://doi.org/10.1086/651706

Blossom DB, McDonald LC. The challenges posed by reemerging Clostridium difficile infection. Clin Infect Dis. 2007;45(2):222-7. DOI: https://doi.org/10.1086/518874

Noren T, Akerlund T, BÃ¤ck E, SjÃ¶berg L, Persson I, Alriksson I, et al. Molecular epidemiology of hospitalassociated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol. 2004;42(8):3635â€“43. DOI: https://doi.org/10.1128/JCM.42.8.3635-3643.2004

Cramer JP, Burchard GD, Lohse AW. [Old dogmas and new perspectives in antibiotic-associated diarrhea] Med Klin (Munich). 2008;103(5):325-38. DOI: https://doi.org/10.1007/s00063-008-1040-0

Blanckaert K, Coignard B, Grandbastien B, Astagneau P, Barbut F. Update on Clostridium difficile infections. Rev Med Interne. 2008;29(3):209-14. DOI: https://doi.org/10.1016/j.revmed.2007.09.029

Kuijper EJ, Coignard B, Tull P. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect. 2006;12(Suppl 6):2-18. DOI: https://doi.org/10.1111/j.1469-0691.2006.01580.x

Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity mortality. N Engl J Med. 2005;353(23):2442-9. DOI: https://doi.org/10.1056/NEJMoa051639

Stojanovic P, Kocic B. Diarrhoea caused by Clostridium difficile in patients with postoperative subhepatic abscess. Vojnosanit Pregl. 2008;65(3):249-54. DOI: https://doi.org/10.2298/VSP0803249S

Kocic B, Stojanovic P. Clinical importance of Clostridium difficile finding in hospitalized patients. Med Pregl. 2008;61(11-12):632-7. DOI: https://doi.org/10.2298/MPNS0812632K

Kelly CP, Pothoulakis C, LaMont JT. Clostridium difficile colitis. N Engl J Med. 1994;330 (4):257-62. DOI: https://doi.org/10.1056/NEJM199401273300406

Bignardi GE. Risk factors for Clostridium difficile infection. J Hospital Infect. 1998; 40(1):1-15. DOI: https://doi.org/10.1016/S0195-6701(98)90019-6

Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002; 346(5):334â€“9. DOI: https://doi.org/10.1056/NEJMcp011603

Zilberberg MD, Shorr AF, Kollef MH. Increase in adult Clostridium difficile-related hospitalizations and casefatality rate, United States, 2000-2005. Emerg Infect Dis. 2008; 14(6):929-31. DOI: https://doi.org/10.3201/eid1406.071447

Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002;235(3):363â€“72. DOI: https://doi.org/10.1097/00000658-200203000-00008

Walker KJ, Gilliland SS, Vance-Bryan K, Moody JA, Larsson AJ, Rotschafer JC, Guay DR. Clostridium difficile colonization in residents of long-term care facilities: prevalence and risk factors. J Am Geriatr Soc. 1993;41(9):940â€“6. DOI: https://doi.org/10.1111/j.1532-5415.1993.tb06759.x

Dharmarajan T, Sipalay M, Shyamsundar R, Norkus E, Pitchumoni C. Co-morbidity, not age predicts adverse outcome in Clostridium difficile colitis. World J Gastroenterol. 2000;6(2):198â€“201.

Lesna M, Parham DM. Risk of diarrhoea due to Clostridium difficile during cefotaxime treatment. Mortality due to C. difficile colitis in elderly people has been underestimated. BMJ. 1996;312(7033):778. DOI: https://doi.org/10.1136/bmj.312.7033.778a

Moshkowitz M, Ben-Baruch E, Kline Z, Shimoni Z, Niven M, Konikoff F. Risk factors for severity and relapse of pseudomembranous colitis in an elderly population. Colorectal Dis. 2007;9(2):173-7. DOI: https://doi.org/10.1111/j.1463-1318.2006.01013.x

Barbut F, Richard A, Hamadi K et al. Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2000;38(6):2386â€“8. DOI: https://doi.org/10.1128/.38.6.2386-2388.2000

Maroo S, Lamont JT. Recurrent clostridium difficile. Gastroenterology. 2006;130(4): 1311-6. DOI: https://doi.org/10.1053/j.gastro.2006.02.044

Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, et al. Increasing risk of relapse after treatment of clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40(11):1591-7. DOI: https://doi.org/10.1086/430315

Johnson S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. Journal of Infection. 2009;58(6):403-10. DOI: https://doi.org/10.1016/j.jinf.2009.03.010

Hookman P, Barkin J. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol. 2009;15(13):1554-80. DOI: https://doi.org/10.3748/wjg.15.1554

Elixhauser A, Jhung M. Clostridium Difficile-Associated Disease in U.S. Hospitals, 1993â€“2005. HCUP Statistical Brief #50 April 2008. Agency for Healthcare Research and Quality, Rockville MD. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb50.pdf.

Jump RL, Pultz MJ, Donskey CJ. Vegetative Clostridium difficile survives in room air on moist surfaces and in gastric contents with reduced acidity: a potential mechanism to explain the association between proton pump inhibitors and C. difficile-associated diarrhea? Antimicrob Agents Chemother. 2007;51(8):2883â€“7. DOI: https://doi.org/10.1128/AAC.01443-06

Tleyjeh IM, Bin Abdulhak AA, Riaz M, Alasmari FA, Garbati MA, AlGhamdi M, et al. Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis. PLoS One. 2012;7(12):e50836. DOI: https://doi.org/10.1371/journal.pone.0050836

Nerandzic MM, Pultz MJ, Donskey CJ. Examination of potential mechanisms to explain the association between proton pump inhibitors and Clostridium difficile infection. Antimicrob Agents Chemother. 2009;53(10):4133â€“7. DOI: https://doi.org/10.1128/AAC.00252-09