According to a recent publication (Clin Gastroenterol Hepatol 2013; 11: 1466-71), the most important risk factors for severe Clostridium difficile infection (CDI) are the following:
- Peripheral leukocytosis (WBC >15,000)
- Elevated serum creatinine >1.5 times baseline
- Narcotic use
- Acid-blocking medications
- Older age
This study reviewed the records of inpatient cases at the Mayo clinic between 2007-2010. In total, 487 of 1446 patients had severe CDI, defined as ICU admssion (26.7%), colectomy (2.7%) or death (8.9%) within 30 days of diagnosis.
Patients with these risk factors may need to be treated more aggressively.
Also, noted: Am J Gastroenterol 2013; 108: 1794-1801. (Thanks to Ben Gold). Using electronic medical records, the authors identified 894 adult inpatients with a first-time CDI (2009-2012). Receipt of PPIs concurrent with CDI treatment was not associated with CDI recurrence.
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