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 diagnosed between 2007 and 2010 were identified.
Recurrent CDI was defined as recurrence of diarrhoea with a positive C. difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms.
The team excluded patients who had 2 positive tests within 14 days.
|Concomitant antibiotic use was associated with risk of recurrent CDI|
|Alimentary Pharmacology & Therapeutics|
Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI.
The cohort included 520 out-patients, of which 104 had recurrent CDI.
The researchers 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.
On further analysis, the team found that concomitant antibiotic use was associated with risk of recurrent CDI.
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."