Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis.

Martijn P Bauer, Marjolein P M Hensgens, Mark A Miller, Dale N Gerding, Mark H Wilcox, Adam P Dale, Warren N Fawley, Ed J Kuijper, Sherwood L Gorbach

Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2012;55 Suppl 2(Suppl 2):S149-53

PMID: 22752864

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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.

Address: Leiden University Medical Center, Leiden, The Netherlands.

DOI: 10.1093/cid/cis340

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MeSH Terms: Aminoglycosides, Anti-Bacterial Agents, Clostridioides difficile, Clostridium Infections, Confidence Intervals, Creatine, Fever, Fidaxomicin, Humans, Leukocyte Count, Leukocytosis, Odds Ratio, Prognosis, ROC Curve, Randomized Controlled Trials as Topic, Recurrence, Renal Insufficiency, Severity of Illness Index, Time Factors, Treatment Failure, Vancomycin