Methods: We included consecutive patients with a minimum of 3 CDI episodes from 2008-2014 (cases) and randomly chosen (4:1) controls that had only one CDI episode. Controls were matched by year and testing modality (EIA or PCR). We used data from the day of diagnosis of the initial CDI episode to identify factors associated with future development of multiple recurrences.
Results: We included 41 cases and 164 controls. Cases’ mean number of CDI episodes was 3.8 (3-9) with a median time from the initial CDI to the 3rd episode of 15 weeks. The average age was 60 years, 38% were >70 years, 51% female, 75% Caucasian, 17% were nursing home residents, 10% were treated as outpatients, and 48% of inpatients were diagnosed later than their second hospital day. Of included subjects, 40% received antibiotics and 56% received acid lowering agents in the two weeks pre-CDI. No differences in medication exposure between cases and controls were identified. In univariate analyses, cases were more likely to be women (29, 71% vs 71, 43%, p<0.01), have chronic lung disease (15, 37% vs 32, 19.6%, p=0.02), have received TPN in the past four weeks (6, 15% vs 8, 5%, p=0.03), and having diarrhea upon their initial care contact (19, 48% vs 38, 23%, p<0.01). Factors associated with multiple recurrences in univariate analyses were also found to be independent risk factors in multivariate analysis: female OR 2.8, 95% CI 1.3-6.2, chronic lung disease 2.5, 1.1-5.7, TPN receipt 3.8, 1.1-12.9, diarrhea upon initial contact 2.9, 1.4-6.3. A simple score based on the number of risk factors was found to be useful in predicting multiple recurrences. The risk of multiple recurrences among subjects with 0, 1, and 2-or-more risk factors was 3%, 17%, and 41%, respectively (p<0.01, C=0.744).
Conclusion: In this first analysis of risk factors for multiple CDI episodes we identified several risk factors that can help stratify patients to early management with newer therapies that can lower CDI recurrence but are too costly to be used in patients at low recurrence risk. Our findings require validation in a larger study.
K. Lai, None
K. Lee, None
Y. Golan, Merck: Consultant , Research Contractor , Scientific Advisor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium