Clinical and Microbiological Risk Factors for Severe Clostridioides difficile Infections
1Department of Laboratory Medicine National Health Insurance Service Ilsan Hospital, Goyang
2Department of Laboratory Medicine, Yongin Severance Hospital, YongIn
3Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
ABSTRACT
Background: There has been a marked increase in the mortality rate associated with Clostridioides difficile infection (CDI) globally since 2003, with the emergence of binary toxin-producing ribotype 027 strains. However, the molecular epidemiology of C. difficile shows regional differences and ribotype 027 is not common in Korea. In this study, the risk factors for severe CDI were evaluated, while considering the region-specific molecular epidemiology.
Methods: A retrospective case-control study was performed. Cases (n = 149) included patients with severe CDI or severe complicated CDI. Controls (n = 155) consisted of patients with non-severe CDI.
Results: Advanced age (odds ratio [OR] = 1.017, P = 0.0358), a history of chemotherapy (OR = 2.695, P = 0.0464), and ribotype 002 (OR = 3.406, P = 0.0231) were statistically significant factors associated with severe CDI in a multivariate analysis.
Conclusion: Ribotype 002 was found to be a significant risk factor for severe CDI in this study. Therefore, the surveillance of C. difficile ribotypes is recommended to monitor the spread of high-risk clones.
Keywords
Clostridioides difficile, Risk factor, Severe infection
Figures & Tables
Table 1. Comparison of severe (or severe complicated) CDI and non-sever eCDI (to be continued)
|
Variable |
Severe or severe complicated CDI (n = 149) |
Non-severe CDI (n = 155) |
P-value |
|
Age (yr) |
74.0+15.0 |
65.9+18.3 |
< 0.0001 |
|
Sex, male |
70 (47.0) |
70 (45.2) |
0.7505 |
|
Hospital-associated |
100 (67.1) |
94 (60.7) |
0.2411 |
|
Charlson comorbidity index |
2.4+1.7 |
2.5+1.8 |
0.6365 |
|
Associated disease |
|||
|
Biliary tract disease |
5 (3.4) |
7 (4.5) |
0.6047 |
|
Cancer |
32 (21.5) |
47 (30.3) |
0.0799 |
|
Pneumonia |
33 (22.2) |
14 (9.0) |
0.0021 |
|
Heart failure |
10 (6.7) |
2 (1.3) |
0.0295 |
|
Chronic respiratory disease |
6 (4.0) |
2 (1.3) |
0.1574 |
|
Chronic renal disease |
29 (19.5) |
27 (17.4) |
0.6460 |
|
Diabetes mellitus |
28 (18.8) |
20 (13.0) |
0.1613 |
|
Cerebrovascular disease |
12 (8.1) |
17 (11.0) |
0.3890 |
|
Alcohol disorder |
1 (0.7) |
1 (0.7) |
0.9776 |
|
Atherosclerosis |
3 (2.0) |
4 (2.6) |
0.7423 |
|
Esophageal disorder |
1 (0.7) |
0 (0.0) |
0.9856 |
|
Nutrition deficiency |
6 (4.0) |
1 (0.7) |
0.0859 |
|
Inflammatory bowel disease |
1 (0.7) |
5 (3.2) |
0.1474 |
|
Gastric ulcer |
2 (1.3) |
1 (0.7) |
0.5477 |
|
Liver cirrhosis |
1 (0.7) |
3 (1.9) |
0.3556 |
|
History of antimicrobial use |
|||
|
Any |
137 (92.0) |
135 (87.1) |
0.1720 |
|
Penicillin |
39 (26.2) |
24 (15.5) |
0.0228 |
|
Narrow-spectrum cephalosporin |
10 (6.7) |
23 (14.8) |
0.0262 |
|
Extended-spectrum cephalosporin |
40 (26.9) |
48 (31.0) |
0.4285 |
|
Inhibitor-combination |
23 (15.4) |
22 (14.2) |
0.7604 |
|
Carbapenem |
36 (24.2) |
21 (13.6) |
0.0191 |
|
Fluoroquinolone |
37 (24.8) |
27 (17.4) |
0.1145 |
|
Teicoplanin |
19 (12.8) |
8 (5.2) |
0.0243 |
|
History of PPI use |
10 (6.7) |
16 (10.3) |
0.2638 |
|
History of chemotherapy |
13 (8.7) |
13 (8.4) |
0.9162 |
|
Treatment |
|||
|
Antimicrobial stop |
78 (52.4) |
80 (51.6) |
0.8978 |
|
Metronidazole |
26 (17.5) |
17 (11.0) |
0.1077 |
|
Vancomycin |
54 (36.2) |
44 (28.4) |
0.1437 |
|
Prognosis |
|||
|
Recovery |
118 (79.2) |
145 (93.6) |
0.0005 |
|
Recurrence |
6 (4.0) |
10 (6.5) |
0.3482 |
|
CDI-related mortality |
1 (0.7) |
1 (0.7) |
0.9776 |
|
Crude mortality |
26 (17.5) |
7 (4.5) |
0.0007 |
|
History of CDI |
2 (1.3) |
2 (1.3) |
0.9683 |
|
C. difficile toxin |
|||
|
A+B+CDT+ |
5 (3.4) |
12 (7.7) |
0.1057 |
|
B only |
11 (7.4) |
6 (3.9) |
0.1901 |
|
A+B+CDT- |
133 (89.3) |
137 (88.4) |
0.8091 |
|
C. difficile ribotype |
|||
|
AB24 (ST129) |
5 (3.4) |
4 (2.6) |
0.6919 |
|
AB25 (ST102) |
4 (2.7) |
7 (4.5) |
0.3978 |
|
Ribotype 001 |
4 (2.7) |
12 (7.7) |
0.0590 |
|
Ribotype 002 |
16 (10.7) |
6 (3.9) |
0.0265 |
|
Ribotype 012 |
4 (2.7) |
10 (6.5) |
0.1290 |
|
Ribotype 014/020 |
20 (13.4) |
28 (18.1) |
0.2687 |
|
Ribotype 017 |
8 (5.4) |
4 (2.6) |
0.2219 |
|
Ribotype 018 |
42 (28.2) |
24 (15.5) |
0.0080 |
|
Ribotype 046 |
5 (3.4) |
5 (3.2) |
0.9494 |
|
Ribotype 070 |
2 (1.3) |
5 (3.2) |
0.2891 |
|
Ribotype 106 |
10 (6.7) |
9 (5.8) |
0.7448 |
|
Others* |
29 (19.5) |
41 (26.5) |
0.1492 |
|
Data in number (%) except for age, Charlson comorbidity index, and laboratory findings, which were in mean + standard deviation. |
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