Vnitr Lek 2013, 59(1):23-30

Risk factors for relapsing and severe Clostridium difficile infection

L. Vojtilová^1,*, M. Pýchová¹, M. Freibergerová¹, J. Juránková², Z. Bortlíček³, P. Husa¹

¹ Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Husa, CSc.

² Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednostka prim. MUDr. Alena Ševčíková

³ Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph.D.

Background:
Describe risk factors for relapsing and severe Clostridium difficile infection (CDI) in a set of patients hospitalized at the Clinic of infectious diseases the University Hospital Brno.

Material and methods:
A retrospective study observing epidemiological, clinical and laboratory data of 281 patients with proven diagnosis of Clostridium difficile infection hospitalized in the period from 1. 1. 2007 to 31. 12. 2010.

Results:
In the first part of the evaluation were enrolled 233 patients, 87 (37.3 %) patients had a record of relapsing CDI and 146 (62.7 %) patients had nonrelapsing CDI. Factors associated with relaps included 2 or more comorbidities, previous hospitalization during the 4 weeks before CDI, the use of proton pump inhibitors. In the second part of the evaluation were enrolled all 281 patients, severe CDI during any episode of the disease was observed in 181 (64.4 %) patients, while the remaining 100 (35.6 %) patients had mild or moderate CDI. The risk factors associated with severe CDI were age older than 65 years, history of coronary heart disease, chronic renal insufficiency, a combination of 2 or more comorbidities, previous hospitalization in a period of 4 weeks.

Conclusions:
Age older than 65 years is the risk for severe CDI. Patients with 2 or more comorbidities or with history of previous hospitalization are in a risk for both, relapsing and severe CDI. Use of proton pump inhibitors may lead to recurrence, probably on the basis of re-infection Clostridium difficile spores.

Keywords: Clostridium difficile infection; risk factors for relapsing CDI; risk factors for severe CDI

Received: October 10, 2012; Accepted: November 27, 2012; Published: January 1, 2013  Show citation