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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
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
1058-4838
S149-S153
Bauer, Martijn P
e141f84f-ac28-4067-b1a2-904773fc0cb4
Hensgens, Marjolein P M
7f3911f7-d102-4e41-a4d7-fe6dd84cc66a
Miller, Mark A
8097b52f-a4e1-437b-8f8b-8abf0f50779c
Gerding, Dale N
abbd3ebd-2c5c-4947-940b-3fc005e54e04
Wilcox, Mark H
52edaf9e-38ef-486f-906c-4613273d1a3d
Dale, Adam P
5096a630-1d0b-4e37-a1d4-e971e08acb54
Fawley, Warren N
6122a762-ccfd-4e35-90e7-178ade6c8ec2
Kuijper, Ed J
fe82764d-7d3b-44b8-9ac2-c1bb6d2486f6
Gorbach, Sherwood L
840c986d-6eb0-4144-a860-7a6a5d9fd44b
Bauer, Martijn P
e141f84f-ac28-4067-b1a2-904773fc0cb4
Hensgens, Marjolein P M
7f3911f7-d102-4e41-a4d7-fe6dd84cc66a
Miller, Mark A
8097b52f-a4e1-437b-8f8b-8abf0f50779c
Gerding, Dale N
abbd3ebd-2c5c-4947-940b-3fc005e54e04
Wilcox, Mark H
52edaf9e-38ef-486f-906c-4613273d1a3d
Dale, Adam P
5096a630-1d0b-4e37-a1d4-e971e08acb54
Fawley, Warren N
6122a762-ccfd-4e35-90e7-178ade6c8ec2
Kuijper, Ed J
fe82764d-7d3b-44b8-9ac2-c1bb6d2486f6
Gorbach, Sherwood L
840c986d-6eb0-4144-a860-7a6a5d9fd44b

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), S149-S153. (doi:10.1093/cid/cis340).

Record type: Article

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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More information

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

Identifiers

Local EPrints ID: 453887
URI: http://eprints.soton.ac.uk/id/eprint/453887
ISSN: 1058-4838
PURE UUID: ec4ec70d-5a4e-4b99-8f2d-36f27b6d2f92
ORCID for Adam P Dale: ORCID iD orcid.org/0000-0001-8163-7481

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Date deposited: 25 Jan 2022 17:44
Last modified: 14 Jul 2022 01:56

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Contributors

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 ORCID iD
Author: Warren N Fawley
Author: Ed J Kuijper
Author: Sherwood L Gorbach

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