Risk Factors for Recurrence of Clostridium Difficile-associated Diarrhea

Background: Clostridium difficile associated disease (CDAD) is one of the most common causes of hospital-acquired diarrhea. Despite increasing incidence of clostridium difficile-associated diarrhea, there are few data on risk factors associated with its relapse.

Patients and Methods: We studied retrospectively possible risk factors for the recurrence of CDAD. 124 patients fulfilled the criteria of CDAD during the study period between January 2006 and July 2009. After successful treatment, recurrence occurred in 20 patients.

Results: Advanced kidney disease (Stage III – IV) was found in 15 patients (75%, p=0.448) in the relapse group versus 69 patients (66.3%) in the non relapse group. Fluoroquinolone accounted for 60% (12 patients, p=0.329) of the prescribed antimicrobial agents in the relapse group compared with 48% (50 patients) in the non relapse group.

19 patients (95%, p=0.029) in the relapse group were on long term proton pump inhibitor therapy compared to 77 patients (74%) in the non relapse group.

There was no statistically significant difference in severity (CRP: p=0.442, leucocytosis: p=0.415) and length of hospitalization (p=0.539) in both studied groups; however, CDAD-relapse was associated with more hospital readmissions and increased health care costs.

Conclusion: Proton pump inhibitor therapy may be associated with increased risk of recurrence of CDAD, and represents a relevant, yet correctable risk factor. In patients at risk for CDAD, proton pump inhibitors should be used carefully.