Clinical Predictors of Recurrence After Primary Clostridioides difficile Infection : A Prospective Cohort Study
BACKGROUND: Recurrent Clostridioides difficile infection (CDI) is a major public health threat. While clinical prediction tools exist, they do not incorporate the newest Infectious Diseases Society of America guidelines.
METHODS: This was a prospective longitudinal study of patients experiencing their first episode of uncomplicated CDI. Patients were followed from diagnosis through 8 weeks post-completion of their anti-CDI therapy to assess recurrence. Stool was collected at diagnosis and weekly for 8 weeks following treatment. Recurrence was defined as diarrhea as well as a positive stool test by toxin EIA (EIA) for C. difficile. Fisher's exact test for binary variables and Student's t test for continuous variables were performed. Cox regression was performed to assess for predictors of CDI recurrence.
RESULTS: Seventy-five patients were enrolled between August 1, 2015, and September 1, 2018. Mean age 58.1 years ± 15.5, 69.3% female, 74.7% were white, 11.3% had baseline irritable bowel syndrome, and 54.7% were actively using PPIs. Over the 8-week follow-up period, 22 patients developed a confirmed CDI recurrence. Univariate predictors of recurrence included treatment with metronidazole (40.9% vs 15.1%, p = 0.03), initially diagnosis by EIA (77.3% vs 43.4%, p = 0.007) and platelet count (206 ± 72.1 vs 270.9 ± 114.8, p = 0.03). A Cox regression model revealed primary diagnosis by EIA (HR 3.39, 95% CI 1.23, 9.31, p = 0.018) and treatment with metronidazole (HR 3.27 95% CI 1.31-8.19, p = 0.01) remain predictors for CDI recurrence.
CONCLUSION: In a large prospective longitudinal cohort of uncomplicated CDI patients, treatment with metronidazole and diagnosis via EIA were the most robust predictors of CDI recurrence.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:65 |
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| Enthalten in: |
Digestive diseases and sciences - 65(2020), 6 vom: 30. Juni, Seite 1761-1766 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Allegretti, Jessica R [VerfasserIn] |
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| Links: |
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| Themen: |
6Q205EH1VU |
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| Anmerkungen: |
Date Completed 20.10.2020 Date Revised 01.12.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s10620-019-05900-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM302721878 |
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| 100 | 1 | |a Allegretti, Jessica R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical Predictors of Recurrence After Primary Clostridioides difficile Infection |b A Prospective Cohort Study |
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| 500 | |a Date Revised 01.12.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Recurrent Clostridioides difficile infection (CDI) is a major public health threat. While clinical prediction tools exist, they do not incorporate the newest Infectious Diseases Society of America guidelines | ||
| 520 | |a METHODS: This was a prospective longitudinal study of patients experiencing their first episode of uncomplicated CDI. Patients were followed from diagnosis through 8 weeks post-completion of their anti-CDI therapy to assess recurrence. Stool was collected at diagnosis and weekly for 8 weeks following treatment. Recurrence was defined as diarrhea as well as a positive stool test by toxin EIA (EIA) for C. difficile. Fisher's exact test for binary variables and Student's t test for continuous variables were performed. Cox regression was performed to assess for predictors of CDI recurrence | ||
| 520 | |a RESULTS: Seventy-five patients were enrolled between August 1, 2015, and September 1, 2018. Mean age 58.1 years ± 15.5, 69.3% female, 74.7% were white, 11.3% had baseline irritable bowel syndrome, and 54.7% were actively using PPIs. Over the 8-week follow-up period, 22 patients developed a confirmed CDI recurrence. Univariate predictors of recurrence included treatment with metronidazole (40.9% vs 15.1%, p = 0.03), initially diagnosis by EIA (77.3% vs 43.4%, p = 0.007) and platelet count (206 ± 72.1 vs 270.9 ± 114.8, p = 0.03). A Cox regression model revealed primary diagnosis by EIA (HR 3.39, 95% CI 1.23, 9.31, p = 0.018) and treatment with metronidazole (HR 3.27 95% CI 1.31-8.19, p = 0.01) remain predictors for CDI recurrence | ||
| 520 | |a CONCLUSION: In a large prospective longitudinal cohort of uncomplicated CDI patients, treatment with metronidazole and diagnosis via EIA were the most robust predictors of CDI recurrence | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Clostridioides difficile | |
| 650 | 4 | |a Metronidazole | |
| 650 | 4 | |a Microbiome | |
| 650 | 4 | |a Toxin | |
| 650 | 4 | |a Vancomycin | |
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| 650 | 7 | |a Vancomycin |2 NLM | |
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| 700 | 1 | |a Storm, Margaret |e verfasserin |4 aut | |
| 700 | 1 | |a Sitko, Jessica |e verfasserin |4 aut | |
| 700 | 1 | |a Kennedy, Kevin |e verfasserin |4 aut | |
| 700 | 1 | |a Gerber, Georg K |e verfasserin |4 aut | |
| 700 | 1 | |a Bry, Lynn |e verfasserin |4 aut | |
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