1368. Evaluation of the Risk Factors Associated with Severe Clostridium difficile Infection (CDI) in a Veterans Affairs Hospital
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Clostridium Difficile poster ID week 2013- final.pdf (1.8 MB)
  • Background: Clostridium difficile (C. difficile) remains the leading cause of health care-associated infectious diarrhea and its incidence and severity is dramatically increasing.  Several studies have associated advanced age with incidence of CDI, however, its relationship with disease severity remains inconclusive.  Although retrospective studies have identified age over 70 years old as an independent risk factor for severe disease, definitions for severity differ.

    Methods: The objective of this study was to identify risk factors that may be associated with severe CDI.  The primary outcome was to determine the effect of advanced age (≥ 70 years old) on the severity of CDI, while the secondary outcome was to identify other potential risk factors for severe CDI.  Disease severity was classified according to the criteria in the 2010 SHEA/IDSA practice guidelines for CDI.  A retrospective cohort chart review was conducted on hospitalized veterans ≥ 18 years old with a positive stool toxin assay between May 2008 and September 2012. Veterans were excluded if they had a previous episode of CDI within 3 months or if they had other potential causes for diarrhea.  Demographic and disease-specific data were collected. A logistic regression model was used to identify characteristics predictive of disease severity.

    Results: Two hundred and twenty-four veterans were included in the study, with 161 (72%) in the mild-moderate group and 63 (28%) in the severe group. Our regression model found advanced age to be significantly associated with severe CDI (OR 2.43, p≤0.005, 95% CI 1.31-4.50). A larger proportion of veterans were diagnosed with severe CDI in the ICU (p=0.004). Although not statistically significant, there was a trend toward multiple antibiotic use (≥ 3) and association with severe CDI (34% mild-moderate vs. 48% severe, p=0.062). The univariate analysis did not reveal any other characteristics predictive of disease severity.

    Conclusion: Advanced age was associated with severe CDI. A prospective evaluation is warranted to validate this finding.  Efforts to identify patients at risk for severe CDI will be important as it may direct treatment and positively affect outcomes.

    Ursula C. Patel, PharmD, BCPS AQ-ID1, Jerry L. Tuazon, PharmD1, Jeffrey T. Wieczorkiewicz, PharmD, BCPS1,2 and Todd A. Lee, PharmD, PhD3, (1)Edward Hines, Jr. VA Hospital, Hines, IL, (2)Midwestern University Chicago College of Pharmacy, Downers Grove, IL, (3)University of Illinois at Chicago College of Pharmacy, Chicago, IL


    U. C. Patel, None

    J. L. Tuazon, None

    J. T. Wieczorkiewicz, None

    T. A. Lee, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.