933. Risk Factors for Clostridium difficile Infection Recurrence
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Posters
  • CDI recurrence - IDWeek2015 poster.pdf (313.5 kB)
  • Background: In 2011 the US had approximately 83,000 Clostridium difficileinfection (CDI) first recurrences. Identifying patients at risk of recurrent CDI (rCDI) can help tailor management and prevention.

    Methods: Active laboratory- and population-based surveillance for CDI was conducted in 10 geographically-diverse US sites. Adult initial CDI cases (iCDI) were defined as the first positive C. difficiletoxin or molecular assays on stool specimens from patients ≥18 years old with diarrhea or CDI treatment (metronidazole, vancomycin or fidaxomicin) during 2013 who did not have a previous positive specimen in ≥ 1 year; rCDI cases were the subset with a subsequent positive test and diarrhea or treatment 2-26 weeks after the first positive test. Demographics, clinical characteristics, and iCDI treatment were assessed for association with rCDI. Multivariable logistic regression modeling was used to identify risk factors. Validation was performed through bootstrapping.

    Results: Of 4,790 iCDI cases, 42% were ≥65 years old, 63% community-associated, 63% treated with metronidazole, and 20% treated with ≥2 CDI antibiotics; 17% (843) developed rCDI. In multivariable analysis, treatment with ≥2 CDI antibiotics, white race, chronic renal insufficiency, diabetes mellitus and antibiotic use in the 12 weeks prior to iCDI increased the odds of rCDI (Table). The Hosmer-Lemeshow test indicated good model fit (p=0.64). Bootstrap resampling selected the same set of variables with the exception of diabetes mellitus; the average C index was 0.59.

    Conclusion: Multiple factors for rCDI have been identified, including characteristics present at the onset of iCDI as well as treatment with combination therapy, which may reflect more severe or refractory disease. Additional study is warranted to develop a prediction tool identifying patients at high risk for rCDI.

    Table: Multivariable logistic regression model of risk factors for rCDI

    Characteristic

    Adjusted Odds Ratio

    95% CI

    p-value

    Monotherapy

    Reference

     

     

    No CDI-specific antibiotic

    0.53

    0.26-1.12

    0.10

    ≥2 CDI antibiotics

    1.37

    1.12-1.68

    <0.01

    White race

    1.49

    1.16-1.92

    <0.01

    Chronic renal insufficiency

    1.41

    1.10-1.79

    <0.01

    Diabetes mellitus

    1.31

    1.06-1.61

    <0.01

    Preceding antibiotic use

    1.50

    1.21-1.85

    <0.01

    Sujan C. Reddy, MD1,2, Alice Guh, MD, MPH3, Fernanda C. Lessa, MD3, Yi Mu, PhD4, Zintars G. Beldavs, MS5, Corinne M. Davis, MPH6, Ghinwa Dumyati, MD, FSHEA7, Stacy M. Holzbauer, DVM, MPH8,9, Helen L. Johnston, MPH10, Carol Lyons, MPH11, Erin C. Phipps, DVM, MPH12, Lucy E. Wilson, MD13, Lisa G. Winston, MD14,15, Dale N. Gerding, MD, FIDSA16,17, L. Clifford Mcdonald, MD, FSHEA18 and Monica Farley, MD, FIDSA1,2,19, (1)Georgia Emerging Infections Program, Decatur, GA, (2)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (3)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (4)Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, GA, (5)Acute & Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (6)Tennessee Department of Health, Nashville, TN, (7)University of Rochester Medical Center, Rochester, NY, (8)Minnesota Department of Health, Saint Paul, MN, (9)Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, (10)Colorado Department of Public Health and Environment, Denver, CO, (11)Connecticut Emerging Infections Program, New Haven, CT, (12)New Mexico Emerging Infections Program, Albuquerque, NM, (13)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (14)California Emerging Infections Program, Oakland, CA, (15)University of California, San Francisco, School of Medicine, Department of Medicine, San Francisco, CA, (16)Loyola University Chicago Stritch School of Medicine, Hines, IL, (17)Edward Hines Jr. VA Hospital, Hines, IL, (18)Centers for Disease Control and Prevention, Atlanta, GA, (19)Atlanta Veterans Affairs Medical Center, Decatur, GA

    Disclosures:

    S. C. Reddy, None

    A. Guh, None

    F. C. Lessa, None

    Y. Mu, None

    Z. G. Beldavs, None

    C. M. Davis, None

    G. Dumyati, None

    S. M. Holzbauer, None

    H. L. Johnston, None

    C. Lyons, None

    E. C. Phipps, None

    L. E. Wilson, None

    L. G. Winston, None

    D. N. Gerding, Sanofi Pasteur: Board Member , Consulting fee
    Actelion: Board Member , Consulting fee
    Merck: Board Member , Consulting fee
    Rebiotix: Board Member , Consulting fee
    Pfizer: Consultant , Consulting fee
    MedImmune: Consultant , Consulting fee
    DaVoltera: Consultant , Consulting fee
    Summit: Consultant , Consulting fee
    Viropharma/Shire: Consultant , Consulting fee

    L. C. Mcdonald, None

    M. Farley, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.