352. Predictors Of Recurrent Clostridium Difficile Infection: Implications For Initial Management
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • 352_DavidEyre.pdf (9.0 MB)
  • Background: Symptomatic recurrence of Clostridium difficile infection (CDI) following initially successful treatment occurs in ~20% of patients, and is challenging to treat. Identifying those at high risk could allow targeted initial management strategies and improve outcomes.

    Methods: Adult toxin enzyme immunoassay positive CDI cases in a population of ~600,000 persons September 2006-December 2010 were combined with epidemiological/clinical data. The cumulative incidence of recurrence 14+ days after first ever CDI was estimated treating death without recurrence as a competing risk, and predictors identified from cause-specific proportional hazards regression models.

    Results: 1678 adults alive 14 days after their first CDI were included; median age was 77 years, 1340 (80%) had previously been admitted for >8h, and 1191 (78%) were inpatients. 363 (22%) experienced a post-14-day recurrence, and 594 (35%) died without recurrence through March 2011. Recurrence risk was independently higher in patients admitted as emergencies (p=0.006), with previous gastrointestinal ward admission(s) (p=0.02), or last discharged 4-12 weeks before first CDI (p=0.006); and was highest on the day of admission for inpatients (p=0.006). Recurrence risk also increased with increasing age (p=0.0004), previous total hours admitted (p<0.0001) and C-reactive protein at diagnosis (p=0.01). Risk was lower in those tested routinely rather than due to clinical suspicion (p=0.07). There was a non-significant trend towards higher recurrence risk following ST-1/PCR-ribotype 027 CDI versus clade 1 CDI (adjusted RR=1.17 (95% CI 0.90-1.51) p=0.24). 169 (47%) of the 363 recurrences shared one or more STs with the initial CDI and 50 (14%) had no STs in common with the initial CDI. Predictors of the 169 shared ST recurrences were very similar to predictors of all 363 recurrences. Every 1-point increase in a risk score based on these predictors was associated with a ~5% absolute increase in 4 month recurrence risk.

    Conclusion: Risk factors including increasing age, severity of initial disease and hospital exposure can predict recurrent CDI, particularly relapse due to the same strain. These factors could identify patients likely to benefit from enhanced initial CDI treatment.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    David Eyre1, A. Sarah Walker, PhD1, David Wyllie1, Kate Dingle1, David Griffiths1, John Finney1, Lily O'Connor1, Ali Vaughan1, Derrick Crook, MB BCh1, Mark Wilcox2 and Tim Peto, MB BS, DPhil1, (1)NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom, (2)Leeds Teaching Hospitals & University of Leeds, Leeds, United Kingdom

    Disclosures:

    D. Eyre, None

    A. S. Walker, None

    D. Wyllie, None

    K. Dingle, None

    D. Griffiths, None

    J. Finney, None

    L. O'Connor, None

    A. Vaughan, None

    D. Crook, Optimer Pharmaceuticals: Investigator and Scientific Advisor, Consulting fee and Institution received per-case funding to support trial patient expenses

    M. Wilcox, bioMerieux: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings
    Optimer Pharmaceuticals: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings
    Novacta: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings
    Pfizer: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings
    Summit: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings
    The Medicines Company: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings
    Viropharma: Consultant and Grant Investigator, Consulting fee, Research grant and Support to attend meetings

    T. Peto, Optimer Pharmaceuticals: Scientific Advisor, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.