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Five risk factors identified for recurrent C. difficile
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Two common risk factors for recurrent Clostridium difficile infections included older age and renal insufficiency, according to researchers from the Cleveland Clinic.
Modifiable risk factors included antibiotics during follow-up, previous fluoroquinolone use and the use of proton pump inhibitors during follow-up.
“With the changing epidemiology and increasing severity and morbidity, uncertainty remains regarding the current risk factors associated with symptomatic CDI recurrences,” the researchers wrote in Infection Control and Hospital Epidemiology. “Identification of novel and common risk factors can strengthen current risk prediction tools, improve their diagnostic accuracy and help to optimize the management of [recurrent] CDI.”
The researchers conducted a systematic review and meta-analysis to evaluate the risk factors for recurrent CDI. The analysis included 33 studies that reported risk factors: 21 retrospective cohorts, six prospective cohorts, three case-control studies and three studies that were part of randomized controlled trials. The studies comprised 18,530 patients.
A meta-analysis of six studies including 3,375 patients showed that patients aged 65 years or older had a higher risk for recurrent CDI (RR=1.63; 95% CI, 1.24-2.14). In another meta-analysis of nine studies that included 8,194 patients, the use of additional non-CDI antibiotics during the follow-up period was associated with a higher risk for recurrent CDI (RR=1.76; 95% CI, 1.52-2.05).
The risk for recurrent CDI also was higher among patients who previously were treated with fluoroquinolones, according to a meta-analysis of four studies including 6,622 patients (RR=1.42; 95% CI, 1.28-1.57). Another risk factor associated with recurrent CDI was the use of proton pump inhibitors during follow-up, which was demonstrated in a meta-analysis of eight studies, including 4,392 patients (RR=1.58; 95% CI, 1.13-2.21). Lastly, renal insufficiency was associated with an increased risk for recurrent CDI in a meta-analysis of five studies with 1,486 patients (RR=1.59; 95% CI, 1.14-2.23).
“Future work should include a deliberate approach to limiting PPI use in older adults with CDI for 30 to 90 days post diagnosis, as this is potentially the most easily modifiable intervention,” the researchers wrote.
Disclosure: Two researchers have received research grants from 3M, GOJO, Merck, Pfizer and STERIS.
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