Program Schedule

Epidemiology and burden of recurrent Clostridium difficile infections

Session: Oral Abstract Session: Clostridium difficile: Epidemiology, Risk Factors, and Impact
Thursday, October 9, 2014: 2:15 PM
Room: The Pennsylvania Convention Center: 109-AB
Background: Clostridium difficile infection (CDI) is associated with a 22% recurrence rate. However, few studies have focused on multiple recurrences. In order to evaluate the potential of new treatment options targeting specifically recurrences, we assessed the burden of recurrent Clostridium difficile infections (rCDI).

Methods: A retrospective cohort of all adults diagnosed with CDI between 1998 and 2009, identified by a positive cytotoxin assay and ICD-9 CM/10 codes, living in the Sherbrooke area (Quebec, Canada). An rCDI was defined by the reappearance of diarrhea leading to a treatment, with or without a positive toxin assay or an endoscopic evidence of pseudomembranous colitis, within 14 to 60 days following the previous episode.

Results: A total of 1311 patients were included (median age=72.4 years; IQR=54-82). Initial CDI was nosocomial in 35% of cases, followed a previous admission in 22%, and was community-acquired in 44%. The probability of having a first rCDI was 24% (291/1214) excluding deaths and total colectomies within 60 days, a second rCDI 41.3% (105/254), a third 33.3% (31/93), and a fourth or more 24.1% (7/29). 

Table – Burden of rCDI (n(%))


R1 (n=291)

R2 (n=105)

R3 (n=31)


Metronidazole (PO and/or IV)

105/259 (40.5)

16/88 (18.2)

5/23 (21.7)

Median duration (d) (IQR)

10 (4.5-14)

7 (2-14)

6 (5-14)

Vancomycin PO

189/259 (73)

81/88 (92)

20/23 (87)

Median duration (d) (IQR)

14 (13.5-21)

35 (14-42)

32 (14-42)

Occurrence during hospitalisation

63 (21.7)

15/95 (15.8)

2 (6.7)

Outpatient visits*

77/226 (34.1)

23/87 (26.4)

16/28 (57.1)

Admission for rCDI

82 (28.2)

32 (31.7)

9 (30)

Length of stay (d) (median (IQR))

7 (5-18)

7 (3-14)

7 (3-10)

Intensive care unit admission (ICU)

15 (5.2)

4 (3.8)

1 (3.2)

Severe episode (WBC ≥15x103/μL and/or ≥50% increase of baseline creatinine level)

86 (29.5)

25 (23.8)

7 (22.6)

Complications (vasopressor use, ileus, toxic megacolon, perforation or colectomy)

15 (5.2)

5 (4.8)

2 (6.5)

30-day all-cause mortality

26 (8.9)

8 (7.6)

2 (6.5)

*excluding patients already hospitalized 

Conclusion: This study addresses multiple recurrences of both community and hospital-acquired CDI, and demonstrates its substantial burden on health care resources. After each CDI, almost one third of patients needed admission, one fourth developed severe CDI and over 5% developed a complication.

Caroline Sheitoyan-Pesant, MD, Claire Nour Abou Chakra, MSc, Jacques Pepin, MD, MSc, Anais Marcil-Héguy, MSc, Vincent Nault, MSc and Louis Valiquette, MD, MSc, Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada


C. Sheitoyan-Pesant, None

C. N. Abou Chakra, None

J. Pepin, Cubist/Optimer: Investigator, Research grant

A. Marcil-Héguy, None

V. Nault, None

L. Valiquette, Cubist: Consultant, Investigator and Speaker's Bureau, Consulting fee, Educational grant, Research grant and Speaker honorarium
Pfizer: Consultant and Investigator, Consulting fee and Research support
Merck: Investigator, Research grant

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