1398. Patients with first recurrence of C. difficile infection within 3 months are more likely to have multiple recurrences
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: With the increasing incidence and severity of Clostridium difficile infection (CDI), multiple recurrent CDI is now a major clinical challenge. To determine which patients are increased at risk for multiple recurrences CDI, we evaluated the relationship between timing of and number of CDI recurrences.

Methods: We performed a prospective cohort study (NIH/ NIAID 1K23AI074681-01A1, HSR-IRB# 13630) of hospitalized adult patients diagnosed with CDI (5/10-8/11, XPERT, GeneOhm), with no history of chronic diarrhea. Age, Charlson co-morbidity score, clinical factors, and medications were recorded at diagnosis. Subjects were interviewed by phone and medical record reviewed for after diagnosis at 1, 3, 6, and 12 months. Recurrent CDI was defined as a documented positive test in medical record or noted by subject in semi-structured follow-up interview.

Results: 362 subjects enrolled; mean age 62years (sd 17), co-morbidity score 5 (sd 3), day of CDI diagnosis was 6 days (sd 9) after admission and length of stay was 17 days (sd 28). 129 (36%) subjects died within 1 year of CDI with median time to death 39 days (sd 107). 85% (72 of 87) of all relapses occurred within the first 3 months. 75% (52 of 69) of subjects with 1 relapse occurred within 3 months; however, 96% (22 of 23) of subjects with ≥ 2 episodes had the first recurrence within 3 months of CDI diagnosis. Subjects with multiple recurrences had no significant difference in age, length of stay, hospital day at CDI diagnosis, or co-morbidities, compared to subjects with ≤ 1 recurrence.

Conclusion: Multiple recurrent CDI is a clinical dilemma for treating physicians and a significant burden for patients. In our cohort, we found that 96% of subjects with multiple recurrent CDI had their first recurrence within 3 months of initial CDI diagnosis. This finding could highlight the persistence of disturbance of the microbiome in subjects with multiple recurrences and begin to identify patients who would most benefit from early intervention to break the recurrence cycle. Further studies are needed to assess the mechanism of this finding.

Laurie Archbald-Pannone, MD, MPH, Geriatric Medicine, University of Virginia, Charlottesville, VA; Infectious Diseases and International Health, University of Virginia, Charlottesville, VA; Internal Medicine, University of Virginia, Charlottesville, VA and Richard Guerrant, MD, Center for Global Health, University of Virginia School of Medicine, Charlottesville, VA; Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA

Disclosures:

L. Archbald-Pannone, None

R. Guerrant, None

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