| Age >65 years | Yes No |
| Severe or fulminant illness | Yes No |
| Any non-CDI antibiotics used are diagnosis of CDI | Yes No |
Clostridium Difficile Infection (CDI) is the most common cause of hospital-acquired diarrhea the severity of which ranges from mild diarrhea to fulminant pseudomembranous colitis. Although most patients respond well to antibiotic therapy of either metronidazole or oral vancomycin, recurrences are fairly common.
A limited number of studies have looked at risk factors for recurrent CDI. Identification of the high risk population could enable CDI prevention strategies to be designed and appropriately applied.
The 2008 study by Garey, et al., identified increased age, hemodialysis, non-surgical admission and increasing length of stay in the ICU as significantly increasing risk of CDI. This meta-analysis found risk factors for recurrent CDI include:
Hu MY, et al. conducted a study (published in 2009) to prospectively derive and validate a clinical prediction rule for recurrent CDI.
Methods: The clinical prediction rule included the following variables: age >65 years, severe or fulminant illness (by the Horn index), and additional antibiotic use after CDI therapy. A second rule combined data on serum concentrations of immunoglobulin G (IgG) against toxin A with the clinical predictors. Both rules were then evaluated prospectively in 89 patients with CDI.
Presence of each of the 3 variables in the clinical prediction rule was assigned a score of 1 and the total score was summed to predict risk of recurrent CDI. The severity was classified on the basis of total score as follows;
Conclusions: The clinical prediction rule discriminated between patients with and without recurrent CDI, in the validation cohort. The rule correctly classified 77.3% and 71.9% of patients in the derivation and validation cohorts, respectively. The combined rule performed well in the derivation cohort but not in the validation cohort
The authors concluded that the clinical prediction rule for predicting recurrent CDI is reliable and accurate and can be used to identify high risk patients most likely to benefit from prophylactic measures.
References:
Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S12-8.
Garey KW, Dao-tran TK, Jiang ZD, et al. A clinical risk index for Clostridium difficile infection in hospitalised patients receiving broad-spectrum antibiotics. J Hosp Infect. 2008;70(2):142-7.
Garey KW, Sethi S, Yadav Y, et al. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70(4):298-304.
Hu MY, Katchar K, Kyne L, et al. Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection. Gastroenterology. 2009;136(4):1206-14.