Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis
Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis
Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95% CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.
Aminoglycosides/therapeutic use, Anti-Bacterial Agents/therapeutic use, Clostridioides difficile/pathogenicity, Clostridium Infections/complications, Confidence Intervals, Creatine/analysis, Fever/complications, Fidaxomicin, Humans, Leukocyte Count, Leukocytosis/etiology, Odds Ratio, Prognosis, ROC Curve, Randomized Controlled Trials as Topic, Recurrence, Renal Insufficiency/etiology, Severity of Illness Index, Time Factors, Treatment Failure, Vancomycin/therapeutic use
S149-S153
Bauer, Martijn P
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Hensgens, Marjolein P M
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Miller, Mark A
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Gerding, Dale N
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Wilcox, Mark H
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Dale, Adam P
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Fawley, Warren N
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Kuijper, Ed J
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Gorbach, Sherwood L
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August 2012
Bauer, Martijn P
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Hensgens, Marjolein P M
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Miller, Mark A
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Gerding, Dale N
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Wilcox, Mark H
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Dale, Adam P
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Fawley, Warren N
6122a762-ccfd-4e35-90e7-178ade6c8ec2
Kuijper, Ed J
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Gorbach, Sherwood L
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Bauer, Martijn P, Hensgens, Marjolein P M, Miller, Mark A, Gerding, Dale N, Wilcox, Mark H, Dale, Adam P, Fawley, Warren N, Kuijper, Ed J and Gorbach, Sherwood L
(2012)
Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis.
Clinical Infectious Diseases, 55 (Suppl 2), .
(doi:10.1093/cid/cis340).
Abstract
Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95% CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.
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cis340
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Published date: August 2012
Keywords:
Aminoglycosides/therapeutic use, Anti-Bacterial Agents/therapeutic use, Clostridioides difficile/pathogenicity, Clostridium Infections/complications, Confidence Intervals, Creatine/analysis, Fever/complications, Fidaxomicin, Humans, Leukocyte Count, Leukocytosis/etiology, Odds Ratio, Prognosis, ROC Curve, Randomized Controlled Trials as Topic, Recurrence, Renal Insufficiency/etiology, Severity of Illness Index, Time Factors, Treatment Failure, Vancomycin/therapeutic use
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Local EPrints ID: 453887
URI: http://eprints.soton.ac.uk/id/eprint/453887
ISSN: 1058-4838
PURE UUID: ec4ec70d-5a4e-4b99-8f2d-36f27b6d2f92
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Date deposited: 25 Jan 2022 17:44
Last modified: 17 Mar 2024 03:46
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Author:
Martijn P Bauer
Author:
Marjolein P M Hensgens
Author:
Mark A Miller
Author:
Dale N Gerding
Author:
Mark H Wilcox
Author:
Adam P Dale
Author:
Warren N Fawley
Author:
Ed J Kuijper
Author:
Sherwood L Gorbach
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