Older age , use of antibiotics after diagnosis , use of proton pump inhibitors , and strain type were the most frequent risk factors for recurrence .
Older age , leucocytosis , renal failure and co-morbidities were frequent risk factors for complicated CDI .
When considered alone , mortality was associated with age , co-morbidities , hypo-albuminemia , leucocytosis , acute renal failure , and infection with ribotype 027 .
BACKGROUND Clostridium difficile infection ( CDI ) can lead to complications , recurrence , and death .
Numerous studies have assessed risk factors for these unfavourable outcomes , but systematic review s or meta-analyses published so far were limited in scope or in quality .
Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea
BACKGROUND We have reported that symptom-free carriers of Clostridium difficile have a systemic anamnestic immune response to toxin A. The aim of this study was to determine whether an acquired immune response to toxin A , during an episode of C. difficile diarrhoea , influences risk of recurrence . METHODS We prospect ively studied 63 patients with nosocomial C. difficile diarrhoea . Serial serum IgA , IgG , and IgM concentrations against C. difficile toxin A , toxin B , or non-toxin antigens were measured by ELISA . Individuals were followed for 60 days . FINDINGS 19 patients  died ( 30 % ) . Of the 44 who survived , 22 had recurrent C. difficile diarrhoea . Patients with a single episode of C. difficile diarrhoea ( n=22 ) had higher concentrations of serum IgM against toxin A on day 3 of their first episode of diarrhoea than those with recurrent diarrhoea ( n=22 , p=0.004 ) . On day 12 , serum IgG values against toxin A were higher in patients who had a single episode of diarrhoea ( n=7 ) than in those who subsequently had recurrent diarrhoea ( n=9 , p=0.009 ) . The odds ratio for recurrence associated with a low concentration of serum IgG against toxin A , measured 12 days after onset of C. difficile diarrhoea , was 48.0 ( 95 % CI 3.5 - 663 ) . INTERPRETATION A serum antibody response to toxin A , during an initial episode of C. difficile diarrhoea , is associated with protection against recurrence
Older age , use of antibiotics after diagnosis , use of proton pump inhibitors , and strain type were the most frequent risk factors for recurrence .
Older age , leucocytosis , renal failure and co-morbidities were frequent risk factors for complicated CDI .
When considered alone , mortality was associated with age , co-morbidities , hypo-albuminemia , leucocytosis , acute renal failure , and infection with ribotype 027 .
BACKGROUND Clostridium difficile infection ( CDI ) can lead to complications , recurrence , and death .
Numerous studies have assessed risk factors for these unfavourable outcomes , but systematic review s or meta-analyses published so far were limited in scope or in quality .