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Risk factors for poor outcome in community-onset Clostridium difficile infection

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Authors
Lee, Eunyoung; Song, Kyoung-Ho; Bae, Ji Yun; Yoon, Doran; Hwang, Joo-Hee; Choe, Pyoeng Gyun; Park, Wan Beom; Bang, Ji Hwan; Kim, Eu Suk; Park, Sang Won; Kim, Nam Joong; Oh, Myoung-don; Kim, Hong Bin
Issue Date
2018-06-15
Citation
Antimicrobial Resistance & Infection Control, 7(1):75
Keywords
Clostridium difficileCommunity-acquired infectionsAnemiaProton pump inhibitorsMortalityRisk factors
Abstract
Background
A substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI.

Methods
We performed a retrospective review of all inpatients with CDI, in a 1300-bed tertiary-care hospital in Korea, from 2008 through 2015. CO-CDI was defined as CDI occurring within 48 h of admission. Poor outcome was defined as follows: 1) all-cause 30-day mortality, 2) in-hospital mortality, or 3) surgery due to CDI.

Results
Of a total 1256 CDIs occurring over 8 years, 152 (12.1%) cases were classified as CO-CDI and 23 (15.1%) had a poor outcome, including 22 (14.5%) cases of mortality and 2 (1.3%) cases of surgery. Patients with a poor outcome had a higher mean age than those without a poor outcome (75.8 vs. 69.6 years, p = 0.03). The proportion of men and prior proton pump inhibitor (PPI) use were significantly higher in the poor outcome group (65.2% vs. 41.9%, p = 0.04; 39.1% vs. 17.6%, p = 0.02, respectively). Multivariate binary logistic model showed that PPI use and anemia (hemoglobin < 10 g/dL) at presentation were significantly associated with a poor outcome (adjusted odds ratio [aOR], 3.76; 95% confidence interval [95CI], 1.26–11.21, aOR, 4.67; 95CI, 1.52–14.34, respectively).

Conclusions
Clinicians should not only be aware of the possibility of CDI in the community setting but also pay more attention to PPI-using elderly patients with anemia in consideration of a poor outcome.
ISSN
2047-2994
Language
English
URI
http://hdl.handle.net/10371/142760
DOI
https://doi.org/10.1186/s13756-018-0365-6
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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