New Method to Determine Risk Factors for Poor Outcome in C. difficile

Rachel Lutz

High bacterial load, gender, and age are predictors of poor outcomes in C. difficile.

High bacterial load, gender, and age are predictors of poor outcomes in Clostridium difficile (C. difficile) infection, according to a new report.

Researchers from Madrid prospectively identified infected patients to identify some early predictors of poor outcome with the C. difficile infection. The 204 patients were all older than 2 years of age, and were recruited between January and June 2013 from a large teaching hospital with about 1550 beds.

The investigators collected patients’ data through bedside interviews, reviewing hospital medical records, accessing the local electronic medical information system, and telephoning patients. Some of the data collected by the researchers included age, sex, hospital department, or outpatient clinic diagnosis of C. difficile infection, and history of hospital admissions up to 3 months prior to infection diagnosis. The researchers also examined the patients’ information in the month leading up to infection, including previous antibiotic use, use of proton-pump inhibitors, use of a nasogastric tube, mechanical ventilation, and surgery.

A total of 45 patients (22.1%) of patients infected with C. difficile were considered to have a poor outcome, the researchers determined, while 33 patients (16.2%) had recurrent infection. Additionally, 4 cases were considered treatment failures and 8 patients progressed to severe complicated disease.

Patients with poor outcomes tended to be older than those without complications — the median age was 74.7 versus 66.6, the investigators reported. The patients with poor outcomes less frequently had a nonfatal underlying disease, as well as a higher Charlson comorbidity index. The authors wrote that there was no significant difference in risk factors among the poor-outcome and without-poor-outcome groups.

In the specific cases of, the authors explained that there were no differences among the 2 outcome groups in terms of pain, duration of diarrhea, or most probable site of infection acquisition. However, they did find that the infection episode was more severe in patients with poor outcomes; those patients also had a longer stay after their diagnosis (16 days vs. 8.5 days) and a longer overall stay (34 days vs. 19 days).

When the patients were diagnosed, those with poor outcomes had a lower lymphocyte count and a higher creatinine level, the researchers discovered, in addition to more frequently presented leukocytosis with a while blood cell count of greater than 15,000 cells per μl. But there were no differences between the groups within the other parameters the researchers analyzed: hemoglobin, platelets, alanine aminotransferase, aspartate aminotransferase, and urea levels.

After multivariable analysis, the study authors learned that independently associated risk factors for a poor outcome included advanced age, female sex, Charlson comorbidity index, and the amount of toxigenic C. difficile at diagnosis.

“Prediction rules are often based on clinical judgment, have complicated scores with a long list of factors to take into account, or are based on radiological findings which are not readily available, whereas ours is based on one simple objective marker which can be available at the time of diagnosis,” Elena Reigadas, PharmD, PhD, one of the study’s authors, told MD Magazine® in an email.

The study, titled “Clinical, Immunological and Microbiological Predictors of Poor Outcome in Clostridium difficile Infection,” was published in the journal Diagnostic Microbiology and Infectious Disease.

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