Risk factors for relapsing and severe Clostridium difficile infection

Česká verzia

Authors: L. Vojtilová ¹; M. Pýchová ¹; M. Freibergerová ¹; J. Juránková ²; Z. Bortlíček ³; P. Husa ¹
Authors place of work: Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Husa, CSc. ¹; Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednostka prim. MUDr. Alena Ševčíková ²; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D. ³
Published in the journal: Vnitř Lék 2013; 59(1): 23-30
Category: Original Contributions

Summary

Background:
Describe risk factors for relapsing and severe Clostridium difficile infection (CDI) in a set of patients hospitalized at the Clinic of infectious diseases the University Hospital Brno.

Material and methods:
A retrospective study observing epidemiological, clinical and laboratory data of 281 patients with proven diagnosis of Clostridium difficile infection hospitalized in the period from 1. 1. 2007 to 31. 12. 2010.

Results:
In the first part of the evaluation were enrolled 233 patients, 87 (37.3 %) patients had a record of relapsing CDI and 146 (62.7 %) patients had nonrelapsing CDI. Factors associated with relaps included 2 or more comorbidities, previous hospitalization during the 4 weeks before CDI, the use of proton pump inhibitors. In the second part of the evaluation were enrolled all 281 patients, severe CDI during any episode of the disease was observed in 181 (64.4 %) patients, while the remaining 100 (35.6 %) patients had mild or moderate CDI. The risk factors associated with severe CDI were age older than 65 years, history of coronary heart disease, chronic renal insufficiency, a combination of 2 or more comorbidities, previous hospitalization in a period of 4 weeks.

Conclusions:
Age older than 65 years is the risk for severe CDI. Patients with 2 or more comorbidities or with history of previous hospitalization are in a risk for both, relapsing and severe CDI. Use of proton pump inhibitors may lead to recurrence, probably on the basis of re-infection Clostridium difficile spores.

Key words:
Clostridium difficile infection – risk factors for relapsing CDI – risk factors for severe CDI

Zdroje

1. Kuijper EJ, van Dissel JT, Wilcox MH. Clostridium difficile: changing epidemiology and new treatment options. Curr Opin Infect Dis 2007; 20: 376–383.

2. Cheknis AK, Sambol SP, Davidson DM et al. Distribution of Clostridium difficile strains from a North American, European and Australian trial of treatment for Clostridium difficile infections: 2005–2007. Anaerobe 2009; 15: 230–233.

3. Akerlund T, Alefjord I, Dohnhammar U et al. Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR – ribotypes 012, 017 and 046 in Sweden, 2008 and 2009. Euro Surveill 2011; 16: pii=19 813.

4. Bauer MP, Notermans DW, van Benthem BH et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011; 377: 63–73.

5. Nyč O, Pituch H, Matějková J et al. Clostridium difficile PCR ribotype 176 in the Czech Republic and Poland. Lancet 2011; 377: 1407.

6. Razavi B, Apisarnthanarak A, Mundy LM. Clostridium difficile: emergence of hypervirulence and fluoroquinolone resistance. Infection 2007; 35: 300–307.

7. Beneš J, Husa P, Nyč O. Doporučený postup diagnostiky a léčby kolitidy vyvolané Clostridium difficile, dostupný na www.infekce.cz.

8. Louie TJ, Miller MA, Mullane KM et al. Fidaxomicin versus Vancomycin for Clostridium difficile Infection. N Eng J Med 2011; 364: 422–431.

9. Hausmann J, Zeuzem S, Schröder O. Fidaxomicin – the next step? A new narrow-spectrum macrocyclic antibiotic for the management of Clostridium difficile infection. Gastroenterology 2011; 141: 1116–1118.

10. Drekonja DM, Butler M, MacDonald R et al. Comparative Effectivenes of Clostridium difficile Treatments. Ann Intern Med. 2011; 155: 839–847.

11. Cornely OA, Crook DW, Esposito R et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis 2012; 12: 281–289.

12. Garey KW, Ghantoji SS, Shah DN et al. A randomized, double-blinded, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. J Antimicrob Chemother 2011; 66: 2850–2855.

13. Polívková S, Sýkorová B, Džupová O et al. Výskyt a charakter infekcí vyvolaných Clostridium difficile u pacientů s průjmovým onemocněním v pražské fakultní nemocnici. Klin mikrobiol inf lek 2010; 16: 206–210.

14. Cohen SH, Gerding DN, Johnson S et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31: 431–455.

15. Ryan C, Murphy C, Twomey C et al. Asymptomatic carriage of Clostridium difficile in an Irish continuing care institution for elderly: prevalence and characteristics. Ir J Med Sci 2010; 179: 245–250.

16. Owens RC. Clostridium difficile – associated disease. Changing epidemiology and implications for management. Drugs 2007; 67: 487–503.

17. Hubert B, Loo VG, Bourgault AM et al. A portrait of the geographic dissemination of the Clostridium difficile North American pulsed-field type 1 strain and the epidemiology of Clostridium difficile-associated disease in Québec. CID 2007; 44: 238–244.

18. Beneš J, Sýkorová B. Kolitida vyvolaná Clostridium difficile. Zpráva z kongresu ICAAC 2006. Klin mikrobiol inf lek 2006; 12: 247–251.

19. Cadena J, Thompson GR 3rd, Patterson JE et al. Clinical predictors and risk factors for relapsing Clostridium difficile infection. Am J Med Sci. 2010; 339: 350–355.

20. Howell MD, Novack V, Grugurich P et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010; 170: 784–790.

21. Cloud J, Kelly CP. Update on Clostridium difficile associated disease. Curr Opin in Gastroenterol 2007; 23: 4–9.

22. DuPont HL, Garey K, Caeiro JP et al. New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control. Curr Opin Infect Dis 2008, 21: 500–507.

23. Dubberke ER, Reske KA, Yan Y et al. Clostridium difficile-associated disease in a setting of endemicity: Identification of novel risk factors. CID 2007; 45: 1543–1549.

24. Kim JW, Lee KL, Jeong JB et al. Proton pump inhibitors as a risk factor for recurrence of Clostridium difficile-associated diarrhea. World J Gastroenterol 2010; 16: 3573–3577.

25. Bergmann D, Koten J, Beneš Z et al. Pseudomembranózní kolitida. Vnitř Lék 2007; 53: 1100–1107.