Background and importance Recurrences in Clostridium difficile infection (CDI) involve increased morbidity and high costs for the healthcare system.
Aim and objectives Analysing the risk of recurrence in patients with CDI according to the prediction scale proposed in the 2020 clinical practice guideline of the Spanish Society of Chemotherapy, Internal Medicine and Anaesthesia and Reanimation. To check whether the calculated risk corresponds to the recurrences presented and to establish the main risk factors observed.
Material and methods Hospitalised patients with CDI were selected from 1 February 2019 to 30 April 2020. The collected data were: sex, age, antibiotics in the previous 3 months and concomitantly with vancomycin or fidaxomicin, immunosuppression, severity (leukocytes >15 000/mm3 or creatinine >1.5 mg/dL), duration of diarrhoea, inflammatory bowel disease (IBD), liver cirrhosis and neoplasia. Recurrence was defined as a new episode of CDI 2–8 weeks after the first episode. The risk of recurrence was calculated using the scale: 1 point for >65 years, immunosuppression, severity, concomitant antibiotics and diarrhoea >5 days: 2 points if episode during previous year, neoplasia, IBD and liver cirrhosis; 3 points if recurrence. A score ≥3 is considered high risk of recurrence.
Results 69 patients with CDI were identified (54% women and 46% men); the median age was 65 years. 88% of patients received antibiotics during the previous 3 months: 39% quinolones, 34% third-generation cephalosporins, 26% amoxicillin-clavulanic acid, 26% piperacillin-tazobactam and 20% carbapenems. Of the 69 patients identified, 20 recurrences were observed, 9 of them with a score ≥3, which represents a degree of coincidence between the scale and the patients studied of 45%. Of the total sample, 36 patients had a score ≥3, and 9 of them had a recurrence (25%). Of the patients with recurrences, the following risk factors were identified: 50% presented immunosuppression, 40% neoplasia, 30% concomitant antibiotics; and 40% of the subjects had neoplasia and immunosuppression.
Conclusion and relevance The calculated risk of recurrence does not correspond to the results obtained in the analysed sample. The choice of treatment should be guided by the patient’s individual risk factors.
Immunosuppression and neoplasia are the main risk factors for recurrence, increasing the risk when both situations coexist.
Conflict of interest No conflict of interest