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Reference: Eyre, DW, Walker, AS, Wyllie, D et al., (2012). Predictors of first recurrence of Clostridium difficile infection: implications for initial management. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 55 Suppl 2 (SUPPL.2), S77-S87.Citable link to this page:

 

Predictors of first recurrence of Clostridium difficile infection: implications for initial management.

Abstract: Symptomatic recurrence of Clostridium difficile infection (CDI) occurs in approximately 20% of patients and is challenging to treat. Identifying those at high risk could allow targeted initial management and improve outcomes. Adult toxin enzyme immunoassay-positive CDI cases in a population of approximately 600,000 persons from September 2006 through December 2010 were combined with epidemiological/clinical data. The cumulative incidence of recurrence ≥ 14 days after the diagnosis and/or onset of first-ever CDI was estimated, treating death without recurrence as a competing risk, and predictors were identified from cause-specific proportional hazards regression models. A total of 1678 adults alive 14 days after their first CDI were included; median age was 77 years, and 1191 (78%) were inpatients. Of these, 363 (22%) experienced a recurrence ≥ 14 days after their first CDI, and 594 (35%) died without recurrence through March 2011. Recurrence risk was independently and significantly higher among patients admitted as emergencies, with previous gastrointestinal ward admission(s), last discharged 4-12 weeks before first diagnosis, and with CDI diagnosed at admission. Recurrence risk also increased with increasing age, previous total hours admitted, and C-reactive protein level at first CDI (all P < .05). The 4-month recurrence risk increased by approximately 5% (absolute) for every 1-point increase in a risk score based on these factors. Risk factors, including increasing age, initial disease severity, and hospital exposure, predict CDI recurrence and identify patients likely to benefit from enhanced initial CDI treatment.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: National Institute for Health Research   Notes:Copyright © 2012 Eyre et al. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please email: journals.permissions[at]oup.com. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bibliographic Details

Publisher: Oxford University Press

Publisher Website: http://global.oup.com/

Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of Americasee more from them

Publication Website: http://cid.oxfordjournals.org/

Issue Date: 2012-8

pages:S77-S87Identifiers

Urn: uuid:f6db6f60-4140-4e79-97e0-c76d015001d5

Source identifier: 344574

Eissn: 1537-6591

Doi: https://doi.org/10.1093/cid/cis356

Issn: 1058-4838 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Infections in Oxfordshire Research Database Humans Clostridium difficile Clostridium Infections Recurrence Treatment Outcome Severity of Illness Index Incidence Proportional Hazards Models Predictive Value of Tests Immunoenzyme Techniques Age Factors Hospitalization Adolescent Adult Aged Aged, 80 and over Child Middle Aged C-Reactive Protein Young Adult Cross Infection Time Factors Risk Factors Female Follow-Up Studies Male Tiny URL: pubs:344574

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Author: Eyre, DW - institutionUniversity of Oxford Oxford, MSD, Medicine, Nuffield Department of - - - Walker, AS - institutionUniversity

Source: https://ora.ox.ac.uk/objects/uuid:f6db6f60-4140-4e79-97e0-c76d015001d5



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