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 .
Factors associated with prolonged symptoms and severe disease due to Clostridium difficile.
OBJECTIVE toxigenic Clostridium difficile is responsible for a spectrum of disease severity ranging from mild diarrhoea to fulminant colitis . This study attempts to determine the proportion of patients in each category of severity and evaluate the risk factors for a more prolonged and complicated course . DESIGN prospect i ve cohort study . SETTING university teaching hospital . SUBJECTS all patients with symptomatic C. difficile infection during 4 months of an outbreak ( January-April 1995 ) ; n=73 ; median age 74 years ( range 17 - 91 ) . MEASUREMENTS incidence of C. difficile-associated disease ( CDAD ) ; severity of disease ; percentage of patients in each category of severity ; risk factors for severe disease/prolonged symptoms ( univariate and multivariable analyses ) . RESULTS the incidence of CDAD was 0.93 % . Of the cases identified , 18 ( 24.7 % ) had mild , self-limiting disease ; 26 ( 35.6 % ) had moderately severe disease ; 23 ( 31.5 % ) had prolonged symptoms and six ( 8.2 % ) had a complicated course . Although CDAD was more common in older patients ( P < 0.001 ) , increasing age was not a risk factor for severity . Significant risk factors for severe CDAD included low Barthel and abbreviated mental test scores ( P < 0.01 , P < 0.001 respectively ) and recent endoscopy ( P=0.03 ) . Logistic regression analysis revealed the following independent predictors of severe CDAD : endoscopy [ odds ratios ( OR ) 4.0 , P=0.03 ] and cognitive impairment ( OR 11.0 , P < 0.01 ) . A trend towards significance was noted for nasogastric tube insertion ( OR 3.1 , P=0.08 ) . Complications of infection included dehydration , malnutrition and faecal incontinence ( which was statistically significantly associated with more severe disease ; P < 0.01 ) . CONCLUSION risk factors for severity of CDAD include functional disability , cognitive impairment , and recent endoscopy . Anticipation of severe CDAD may limit morbidity and mortality
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 .