C.difficile is the most common antibiotic associated diarrhea. Prior antibiotic use is the strongest contributing factor to contracting C.difficile infection. The aim of this study was to look at home narcotic use and severity of C.difficile infection in hospitalized patients based on criteria of systemic inflammatory response (SIRS) .
159 patients with CDI who were admitted during January, 2008 – May, 2013 were included in this retrospective cohort study. Data on demographics characteristics, past medical history, CDI descriptions were collected . Severe CDI was defined as two or more of the following variables fever of more than 38°C (100.4°F) or less than 36°C (96.8°F) ,heart rate of more than 90 beats per minute ,respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg and abnormal white blood cell count (>12,000/µL or < 4,000/µL or >10% immature [band] forms) . Multivariable Logistic Regression was performed. Statistical significance was defined as p value less than 0.05.
The cohort consisted of 50.3% (80 of 192) female with a mean (SD) age of 64.8 years old (20.1). 17 (10.7%) patients were admitted in MICU. The symptoms of CDI were fever 51 (32.1%) patients ,ileus 144 (90.6%) patients ,ascites 21 (13.2%) patients,abdominal pain 2 ( 1.3%) patients,hematochezia 67 (13.38%),patients , alter mental status 3 (1.9%)patients,syncope 1 (0.6%)patients,constipation 3 patients (1.9%),nausea or vomiting 15 (9.4%)patients ,and colitis 18 (11.8%)patients.
Multivariable logistic regression (table2) showed that WBC [odd ratio(OR): ,p 0.003;95%CI:1.05-1.32], heart rate [odd ratio(OR): ,p 0.001;95%CI:1.28-1.15], diabetes [odd ratio(OR): ,p 0.016;95%CI:1.48-43.85],prior narcotic use [odd ratio(OR): ,p 0.011;95%CI:2.33-720],colitis[odd ratio(OR): ,p 0.019;95%CI:1.54-129.4],fever [odd ratio(OR): ,p 0.044;95%CI:1.046-22.8] were independently associated with severe CDI based on SIRS criteria.
In our study, we used SIRS criteria to determine the severity of CDI. We found that peripheral WBC , dabetes ,home narcotic use and albumin level were associated with severity of CDI based on SIRS criteria. Advance age and male gender which were previously found to be associated with a higher severity of CDI, however, were not identified as a predictors for the severity of CDI in this study.
N. Poowanawittayakom, None
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