Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

Authors

  • Bethanne P Carpenter University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
  • Erin K Hennessey St. Louis College of Pharmacy, St. Louis, Missouri, USA. Mercy Hospital St. Louis, St. Louis, Missouri, USA.
  • Alex M Bryant Mercy Hospital St. Louis, St. Louis, Missouri, USA.
  • Jad A Khoury Mercy Hospital St. Louis, St. Louis, Missouri, USA.
  • Andrew J Crannage St. Louis College of Pharmacy, St. Louis, Missouri, USA. Mercy Hospital St. Louis, St. Louis, Missouri, USA.

DOI:

https://doi.org/10.18433/J32S41

Abstract

Purpose. Recurrent Clostridium difficile infection (RCDI) is a growing concern, yet limited data exists to clarify which patients are at highest risk.  Identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. The purpose of this study was to determine which factors are associated with the recurrence of Clostridium difficile infection (CDI) and to develop a risk stratification tool.  Methods. Patients readmitted within 10 weeks of positive C. difficile polymerase chain reaction (PCR) with symptoms were included in this retrospective case control study.  The primary outcome was analyzed via univariate regression analyses of the independent factors including age, gender, number of CDI episodes, administration of acid blocking agents, antibiotics or chemotherapy, Charlson Comorbidity Index, gastrointestinal conditions, and exposure to healthcare facilities.  Results. Recurrent CDI was identified in 44 of 220 included patients.  In the univariate analysis, factors associated with development of RCDI included antibiotic exposure (OR 2.51, 95% CI 1.14-5.54; p 0.02) and inflammatory bowel disease (OR 5.77, 95% CI 1.24-26.79; p 0.03).  An evaluation tool was created from a well-fit model.  Additional factors included in the tool were chosen based on evaluation of findings from existing literature.  Conclusions. Antibiotic therapy and inflammatory bowel disease were found to be associated with RCDI.  Although a statistically significant association with RCDI was not found for other factors, this is likely related to small sample size.  The creation of an evaluation tool using specific patient factors can help determine the risk of RCDI, while future studies may validate this tool.

 

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Author Biographies

Bethanne P Carpenter, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.

PGY2 Infectious Diseases Pharmacy Resident

Erin K Hennessey, St. Louis College of Pharmacy, St. Louis, Missouri, USA. Mercy Hospital St. Louis, St. Louis, Missouri, USA.

Assistant Professor of Pharmacy Practice

Alex M Bryant, Mercy Hospital St. Louis, St. Louis, Missouri, USA.

Clinical Pharmacist, Infectious Diseases

Jad A Khoury, Mercy Hospital St. Louis, St. Louis, Missouri, USA.

Physician, Infectious Diseases

Andrew J Crannage, St. Louis College of Pharmacy, St. Louis, Missouri, USA. Mercy Hospital St. Louis, St. Louis, Missouri, USA.

Associate Professor of Pharmacy Practice

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Published

2016-09-10

How to Cite

Carpenter, B. P., Hennessey, E. K., Bryant, A. M., Khoury, J. A., & Crannage, A. J. (2016). Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool. Journal of Pharmacy & Pharmaceutical Sciences, 19(3), 349–356. https://doi.org/10.18433/J32S41

Issue

Section

Pharmacy Practice, Education & Socioeconomy