TABLE 1.
Univariate analysis of risk factors predicting recurrence of CDIh
| Factor | Value |
Univariate analysis result |
||
|---|---|---|---|---|
| No recurrence (n = 191) | Recurrence (n = 36) | OR (95% CI) | P value | |
| Male gender (n [%]) | 94 (49.2) | 13 (36.1) | 1.71 (0.82–3.58) | 0.14 |
| Age (yr) (mean ± SD) | 63.32 ± 19.48 | 68.84 ± 17.78 | 3.49 (−12.4–1.36) | 0.11 |
| CCI (median [IQR]) | 4 (2–7) | 5 (4–6) | 0.59 | |
| Diabetes mellitus (n [%]) | 27 (14.1) | 8 (22.2) | 1.73 (0.71–4.20) | 0.21 |
| Active malignancya (n [%]) | 33 (17.3) | 7 (19.4) | 1.15 (0.46–2.86) | 0.75 |
| Hematological diseasea (n [%]) | 12 (6.3) | 1 (2.8) | 0.42 (0.05–3.38) | 0.69 |
| Chemotherapya (n [%]) | 23 (12.0) | 4 (11.1) | 0.91 (0.29–2.82) | 1.00 |
| Hematopoietic stem cell transplantationa (n [%]) | 2 (1.0) | 1 (2.8) | 2.70 (0.24–30.59) | 0.40 |
| Solid organ transplantation (n [%]) | 15 (7.9) | 6 (16.7) | 2.34 (0.84–6.52) | 0.11 |
| Chronic renal failure (n [%]) | 29 (15.2) | 10 (27.8) | 2.15 (0.94–4.92) | 0.06 |
| Cirrhosis (n [%]) | 15 (7.9) | 0 (0.0) | 0.83 (0.78–0.88) | 0.13 |
| Concurrent corticosteroid therapy (any dose) (n [%]) | 33 (17.3) | 8 (22.2) | 1.37 (0.57–3.27) | 0.48 |
| Concurrent corticosteroid therapy (high dose)b (n [%]) | 9 (4.7) | 3 (8.3) | 1.84 (0.47–7.15) | 0.41 |
| Other immunosuppression (n [%]) | 36 (18.8) | 7 (19.4) | 1.04 (0.42–2.56) | 0.93 |
| Inflammatory bowel disease (n [%]) | 12 (6.3) | 4 (11.1) | 1.86 (0.56–6.14) | 0.29 |
| Cognitive impairment (n [%]) | 12 (6.3) | 1 (2.8) | 0.42 (0.05–3.38) | 0.70 |
| Admission to long-term care facility (n [%]) | 13 (6.8) | 0 (0.0) | 0.83 (0.78–0.88) | 0.23 |
| PPI therapyc (n [%]) | 115 (60.2) | 26 (72.2) | 1.72 (0.78–3.76) | 0.17 |
| H2 blocker therapyc (n [%]) | 9 (4.7) | 2 (5.6) | 1.19 (0.24–5.75) | 0.68 |
| Prior hospital admissiond (n [%]) | 94 (49.2) | 23 (65.7) | 1.98 (0.93–4.20) | 0.07 |
| No. of admissionsd (median [IQR]) | 1 (0–1) | 1 (0–2) | 0.024 | |
| Prior antibiotic therapy (n [%]) | ||||
| Within 4 weeks prior to diagnosis | 147 (77.0) | 29 (80.6) | 1.24 (0.51–3.02) | 0.63 |
| Within 12 weeks prior to diagnosis | 167 (87.4) | 33 (91.7) | 1.58 (0.45–5.55) | 0.58 |
| CDI symptoms as the main reason for consultatione (n [%]) | 84 (44.0) | 23 (63.9) | 2.25 (1.08–4.71) | 0.028 |
| Leukocytosisf (n [%]) | 41/171 (24.0) | 13/36 (36.1) | 1.79 (0.83–3.85) | 0.13 |
| White blood cell count (median [IQR]) | 8,900 (6,600–14,800) | 11,550 (6,775–16,800) | 0.22 | |
| Fever (n [%]) | 68/191 (35.6) | 15/36 (41.7) | 1.29 (0.62–2.67) | 0.48 |
| Acute renal failureg (n [%]) | 25/181 (13.8) | 9/36 (25.0) | 2.1 (0.87–4.94) | 0.09 |
| Maximum no. of daily bowel movements (median [IQR]) | 5 (3–7) | 7 (5–9) | 0.003 | |
| Severity of symptoms at presentation of CDI (n [%]) | ||||
| Mild or moderate CDI | 147 (77.0) | 22 (61.1) | 1 | |
| Severe CDI | 27 (14.1) | 13 (36.1) | 3.43 (1.55–7.58) | 0.002 |
| Severe-complicated CDI | 17 (8.9) | 1 (2.7) | 0.29 (0.04–2.27) | 0.32 |
| Positive binary toxin (n [%]) | 34 (17.8) | 7 (19.4) | 1.15 (0.45–2.75) | 0.81 |
| Positive EIA result for A/B toxin (n [%]) | 77 (40.3) | 27 (75.0) | 4.44 (1.98–9.96) | 0.000 |
| Toxin B CT value (mean ± SD) | 26.02 ± 4.54 | 24.00 ± 3.28 | 0.79 (0.45–3.58) | 0.002 |
| Concomitant antibiotic during CDI-specific treatment (n [%]) | 134 (70.2) | 24 (66.7) | 0.85 (0.40–1.81) | 0.67 |
| Delay between symptom onset and start of treatment (days) (median [IQR]) | 4.0 (1.0–8.0) | 4.0 (1.0–13.0) | 0.74 | |
| Type of therapy and delay from sample submission to lab | ||||
| No treatment (n [%]) | 35 (18.3) | 1 (2.8) | 7.85 (1.04–59.27) | 0.02 |
| Empirical treatment (n [%]) | 27 (14.1) | 7 (19.4) | 1.46 (0.58–3.68) | 0.41 |
| Advance treatment (days) (median ± SD) | 2.22 ± 1.45 | 2.57 ± 2.63 | 0.73 (−1.15–1.84) | 0.64 |
| Targeted treatment (n [%]) | 126 (81.8) | 28 (77.8) | 1.8 (0.78–4.18) | 0.18 |
| Delay (days) (median ± SD) | 2.19 ± 3 − 04 | 1.07 ± 1.69 | 0.59 (−0.59–2.29) | 0.01 |
| Unknown (n [%]) | 3 (1.6) | 0 (0.0) | 0.84 (0.79–0.89) | 1.00 |
| Treatment (n [%]) | ||||
| Oral metronidazole | 105 (54.9) | 19 (52.7) | 1.41 (0.59–3.38) | 0.43 |
| Intravenous (i.v.) metronidazole | 42 (21.9) | 11 (30.5) | 1.62 (0.74–3.59) | 0.22 |
| Oral vancomycin | 60 (31.4) | 17 (47.2) | 2.06 (0.99–4.28) | 0.049 |
| Enemas of vancomycin | 1 (0.52) | 0 (0.0) | 0.84 (0.79–0.89) | 1.00 |
| Fidaxomicin | 0 (0.0) | 0 (0.0) | ||
| Rifaximin | 7 (3.6) | 0 (0.0) | 0.83 (0.79–0.88) | 0.60 |
| Probiotics | 15 (7.8) | 2 (5.5) | 0.69 (0.15–3.16) | 1.00 |
| Polyclonal gamma globulin | 0 (0.0) | 1 (2.7) | 0.15 (0.11–0.21) | 0.16 |
| i.v. tigecycline | 8 (4.2) | 1 (2.7) | 0.65 (0.08–5.39) | 1.00 |
| Surgical treatment | 0 (0.0) | 0 (0.0) | ||
a
Within the 6 months prior to the diagnosis of CDI.
b
Daily dose of >20 mg of prednisone or equivalent for more than 3 weeks at diagnosis.
c
Within the 4 weeks prior to the diagnosis of CDI.
d
Within the 12 weeks prior to the admission in which diagnosis of CDI was made.
e
To the primary care physician, emergency department, or outpatient facility.
f
White blood cell count of ≥15,000 cells/ml.
g
Increase of serum creatinine of ≥1.5-fold compared to the premorbid level.
h
CCI, age-adjusted Charlson comorbidity index; CDI, Clostridium difficile infection; CI, confidence interval; CT, threshold cycle; EIA, enzyme immunoassay; IQR, interquartile range; OR, odds ratio; PPI, proton pump inhibitors; SD, standard deviation. Statistically significant results are shown in bold.