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 .
A prospective study of risk factors and historical trends in metronidazole failure for Clostridium difficile infection.
BACKGROUND & AIMS Recent studies of Clostridium difficile infection ( CDI ) have indicated a dramatic increase in metronidazole failure . The aims of this study were to compare current and historical rates of metronidazole failure and to identify risk factors for metronidazole failure . METHODS Eighty-nine patients with CDI in 2004 to 2006 were followed for 60 days and were compared with a historical cohort of 63 CDI patients studied prospect ively in 1998 . Metronidazole failure was defined as persistent diarrhea after 10 days of therapy or a change of therapy to vancomycin . Stool sample s were analyzed for the presence of the North American pulsed-field gel electrophoresis type-1 ( NAP-1 ) strain . RESULTS Metronidazole failure rates were 35 % in both cohorts . There was no difference in the median time to resolution of diarrhea ( 8 vs 5 d ; P = .52 ) or the proportion with > 10 days of diarrhea ( 35 % vs 29 % ; P = .51 ) . Risk factors for metronidazole failure included recent cephalosporin use ( odds ratio [ OR ] , 32 ; 95 % confidence interval [ CI ] , 5 - 219 ) , CDI on admission ( OR , 23 ; 95 % CI , 3 - 156 ) , and transfer from another hospital ( OR , 11 ; 95 % CI , 2 - 72 ) . The frequency of NAP-1 infection in patients with and without metronidazole failure was similar ( 26 % vs 21 % ; P = .67 ) . CONCLUSIONS We found no difference in metronidazole failure rates in 1998 and 2004 to 2006 . Patients with recent cephalosporin use , CDI on admission , and transfer from another hospital were more likely to metronidazole failure . Infection with the epidemic NAP-1 strain was not associated with metronidazole failure in endemic CDI
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 .