Clostridium difficile infection (CDI) recurs in 20–30% of patients.
Dr Pardi and colleagues from Minnesota, USA described the predictors of recurrence in out-patients with CDI.
Out-patient cases of CDI in Olmsted County, Minnesota residents diagnosed between 2007 and 2010 were identified.
The researchers defined recurrent CDI as recurrence of diarrhea with a positive C. difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms.
Patients who had two positive tests within 14 days were excluded.
Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI.
|Antibiotic use was associated with recurrent CDI|
|Alimentary Pharmacology & Therapeutics|
The cohort included 520 out-patients, of whom 104 had recurrent CDI.
The research team identified increasing age and antibiotic use to be associated with recurrent CDI.
Severe CDI, peripheral leucocyte count and change in serum creatinine >1.5-fold were not.
The team noted that concomitant antibiotic use was associated with risk of recurrent CDI, while age, peripheral leucocyte count >15 × 109/L, and change in serum creatinine greater than 1.5-fold were not.
Dr Pardi's team concludes, "Antibiotic use was independently associated with a dramatic risk of recurrent Clostridium difficile infection in an out-patient cohort."
"It is important to avoid unnecessary systemic antibiotics in patients with Clostridium difficile infection, and patients with ongoing antibiotic use should be monitored closely for recurrent infection."