Recurrence of Clostridioides difficile infection: A multicenter study on incidence and risk factors

Abstract

Background: The main objective of our study is to assess the incidence of and risk factors for recurrence of C. difficile infection (rCDI) at 4 w after a first CDI. Methods and materials: Patients with a first CDI hospitalized in 13 acute care Italian hospitals have been prospectively included and followed up to 4 weeks after the end of the first CDI. A nested case-control study was performed to identify risk factors associated with rCDI. Results: One hundred ninety-seven patients with first CDI completed the 30 d follow-up for a total of 5,910 d. rCDI occurred in 19% of patients (37/197) with an incidence rate of 70/10,000 patient-days. The mean time from the end of treatment to recurrence was 13 d, 19% of rCDI were severe/complicated (7/37). Patients who presented rCDI were compared with those who did not develop it: at univariate analysis no statistically significant differences were found regarding mean age (69 y vs 68, p = 0.7); exposure in the 3 m previous the first CDI to antibiotics (30/37 vs 105/160, OR 2.2; 95% CI 0.9– 6.4), proton pump inhibitors (26/37 vs 111/160, OR 1; 95% CI 0.5–2.5), statins (9/37 vs 39/160, OR 1; 95% CI 0.4–2.4) and steroid (9/37 vs 51/160, OR 0.7; 95% CI 0.3–1.6); mean serum albumin value at first CDI diagnosis (3.1 vs 3 mg/dl, p = 0.4); severity of first CDI episode (12/37 with severe/complicated vs 37/160, OR 1.6; 95% CI 0.7–3.7) and exposure to antibiotics during the 30 d follow up period (14/37 vs 56/160, OR 1.1; 95% CI 0.5–2.5). Interestingly, 24% (9/37) of patients who presented a rCDI had been treated with sole metronidazole as compared to 12% (20/160) of those who did not present a rCDI (RR 2.25; 95% CI 0.8–5.8, p = 0.07). Conclusion: Our study confirmed the relevance of rCDI and suggested a likely impact on the risk of developing rCDI of the use of metronidazole for the treatment of a first CDI, that deserves further and wider studies.