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Abnormal vital signs, blood tests indicative of C. difficile complications
Complications of Clostridium difficile infections may be more common among patients who have atypical vital signs, high heart and respiratory rates or are aged 80 years or older, according to recently published data.
“The ability to identify patients at high risk of [C. difficile infection complications] early in the course of illness could improve clinical decision-making,” the researchers wrote. “Such patients might benefit from closer monitoring, more aggressive rehydration, selection of vancomycin as a first-line agent, adjunctive treatments or earlier evaluation by surgeons.”
Between June 2005 and October 2008, researchers enrolled adults with C. difficile receiving care at 10 Canadian acute care hospitals. Patient data, including hospital admission, chronic comorbidities, immune status and relevant surgical procedures, were recorded at enrollment, immediately after diagnosis. The researchers also recorded data on antimicrobial therapy, gastric acid suppression and recent use of anti-peristaltic agents. Complications of C. difficile infection were defined as admission to an ICU for C. difficile infection, colonic perforation, toxic megacolon, colectomy or hemicolectomy, or death within 30 days of enrollment related to C. difficile infection. Outcomes were assessed through follow-up evaluations up to 90 days after patient enrollment.
There were 1,380 patients with C. difficile infection enrolled in the study, and follow-up was completed in 1,367 cases. R027 was the most common strain detected through ribotyping, and C. difficile infection complications were observed among 8% of patients.
Factors associated with C. difficile complications included tachypnea, tachycardia and older age. In addition, abnormal blood results such as leukocytosis, leucopenia, azotemia, hypoalbuminemia and high C-reactive protein were associated with infection complications.
“These predictors, readily available at the time of diagnosis, could serve to develop and validate a score aiming to identify patients who could benefit from a more aggressive treatment and closer monitoring,” the researchers wrote.
In a related editorial, David M. Aronoff, MD, of the division of infectious diseases, Vanderbilt University School of Medicine, wrote that these predictors should be explored as clinical guidelines for reducing the impact of C. difficile infection complications in the future.
“What appears to be coming into focus for [C. difficile infection] is that host features are the strongest predictors of adverse outcomes, and robust clinical prediction rules should be built accordingly,” Aronoff wrote. “The challenge now is to show prospectively that any decision rule improves patient care and avoids overuse of limited health care resources.” – by Dave Muoio
Disclosures: Abou Chakra and Aronoff report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.