Methods: We conducted a prospective cohort study of adult inpatients with confirmed CDI in 10 acute-care hospitals across Quebec and Ontario, Canada, with 90-day follow-up (2005-2008). CDI was defined by diarrhea and the detection of CD toxin by EIA or direct cytotoxin assay. rCDI was defined as diarrhea and a positive toxin, or receipt of CDI treatment 48h or more after the completion of initial treatment. Potential risk factors for rCDI were measured at enrollment. Isolates were typed with PCR ribotyping. Risk factors were identified using survival analysis and multivariate Cox hazards modelling.
Results: A total of 1380 patients with CDI were enrolled (median age 71 years; IQR=58-80), among whom 86% were experiencing a primary episode. Most CDI were healthcare facility-associated (90%). Metronidazole was used as treatment for 82% of patients. A stool specimen was collected in 1054 patients, a ribotype was obtained in 922 (67%), and 483 (52%) were R027. At least one rCDI was experienced by 322 patients (23.5%) during a median of 28 days (IQR=20-40) after the initial episode. Independent risk factors for rCDI were age over 80 years (Adjusted hazards ratio [AHR]=1.4; 95% CI=1.06-1.9), duration of hospitalization ≥14 days after CDI diagnosis (AHR=1.5; 95% CI=1.14-2.0), C-reactive protein (CRP) ≥150mg/L (AHR=1.6; 95%CI=1.05-2.6), and R027 (AHR=1.5; 95% CI=1.1-2.0). Underlying diseases (including immunosuppression), previous exposures, use of concomitant antibiotics or proton pump inhibitors, and other ribotypes were not associated with rCDI in multivariate analysis.
Conclusion: Within this large prospective multicenter cohort, older age, increased CRP, ribotype 027, and prolonged hospital stay were associated with rCDI.This study reinforces the association between R027 and rCDI. It demonstrates the need to investigate further the biological basis for relapse in these strains.
C. N. Abou Chakra,
A. C. Labbé, None
A. E. Simor, None
W. Gold, None
M. P. Muller, None
J. Powis, None
K. Katz, None
J. R. Garneau, None
L. C. Fortier, None
J. Pepin, None
L. Valiquette, Cubist/Optimer: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium
Pfizer: Grant Investigator , Research grant
Merck: Grant Investigator , Research grant
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