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684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences

BACKGROUND: Recent advancements in treating Clostridioides difficile infection (CDI) include therapeutics to prevent further recurrence in patients with recurrent CDI (rCDI). However, little is known about which patients are at increased risk for multiple recurrences (≥ 2 rCDI). We sought to identif...

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Autores principales: Guh, Alice, Li, Rongxia, Korhonen, Lauren C, Winston, Lisa Gail, Parker, Erin, Czaja, Christopher A, Johnston, Helen, Basiliere, Elizabeth, Meek, James, Olson, Danyel M, Fridkin, Scott, Wilson, Lucy E, Perlmutter, Rebecca, Holzbauer, Stacy, D’Heilly, Paige, Phipps, Erin, Flores, Kristina, Dumyati, Ghinwa, Pierce, Rebecca, Ocampo, Valerie, Wilson, Christopher, Watkins, Jasmine, Gerding, Dale, Clifford McDonald, L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677783/
http://dx.doi.org/10.1093/ofid/ofad500.746
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author Guh, Alice
Li, Rongxia
Korhonen, Lauren C
Winston, Lisa Gail
Parker, Erin
Czaja, Christopher A
Johnston, Helen
Basiliere, Elizabeth
Meek, James
Olson, Danyel M
Fridkin, Scott
Wilson, Lucy E
Perlmutter, Rebecca
Holzbauer, Stacy
D’Heilly, Paige
Phipps, Erin
Flores, Kristina
Dumyati, Ghinwa
Pierce, Rebecca
Ocampo, Valerie
Wilson, Christopher
Watkins, Jasmine
Gerding, Dale
Clifford McDonald, L
author_facet Guh, Alice
Li, Rongxia
Korhonen, Lauren C
Winston, Lisa Gail
Parker, Erin
Czaja, Christopher A
Johnston, Helen
Basiliere, Elizabeth
Meek, James
Olson, Danyel M
Fridkin, Scott
Wilson, Lucy E
Perlmutter, Rebecca
Holzbauer, Stacy
D’Heilly, Paige
Phipps, Erin
Flores, Kristina
Dumyati, Ghinwa
Pierce, Rebecca
Ocampo, Valerie
Wilson, Christopher
Watkins, Jasmine
Gerding, Dale
Clifford McDonald, L
author_sort Guh, Alice
collection PubMed
description BACKGROUND: Recent advancements in treating Clostridioides difficile infection (CDI) include therapeutics to prevent further recurrence in patients with recurrent CDI (rCDI). However, little is known about which patients are at increased risk for multiple recurrences (≥ 2 rCDI). We sought to identify predictors of multiple rCDI (mrCDI) in adults at the time of presentation with initial CDI (iCDI). METHODS: The Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) conducts population-based CDI surveillance in 10 U.S. sites. We defined iCDI as a positive C. difficile test during January 2018–August 2019 in a person aged ≥ 18 years with no prior positive test reported to EIP. rCDI was defined as a positive test ≥ 14 days from the previous positive test within 180 days after iCDI. All patients with community-onset iCDI and a random sample of patients with healthcare-facility onset iCDI (i.e., hospital-onset, long-term care facility onset) had full chart reviews. Multiple imputation was performed on missing race/ethnicity. Candidate variables determined a priori to be potentially associated with mrCDI were entered into an initial multivariable logistic regression model. Patients without mrCDI who died within 180 days of their iCDI were excluded from the model. Candidate variables with a p-value < 0.1 in the initial model were included in the final model. RESULTS: Of 18,829 patients with iCDI, 882 (4.7%) had mrCDI, ranging from 2 to 5 rCDI per patient in the 180 days following iCDI. Median time between each rCDI was 43 days (interquartile range: 27–65 days). Full charts were reviewed for 435 iCDI patients with mrCDI and 7474 iCDI patients without mrCDI. Characteristics of patients with and without mrCDI are shown in Table 1. In multivariable analysis, age ≥ 65 years, recent hospitalization, chronic hemodialysis, and recent nitrofurantoin use were significantly associated with mrCDI (Table 2). [Figure: see text] [Figure: see text] CONCLUSION: Patients with iCDI who are older, on hemodialysis, or had recent hospitalization or nitrofurantoin use may be at increased risk of mrCDI and may benefit from early use of adjunctive therapy to prevent mrCDI. If confirmed, these findings would aid in clinical decision making. DISCLOSURES: Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
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spelling pubmed-106777832023-11-27 684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences Guh, Alice Li, Rongxia Korhonen, Lauren C Winston, Lisa Gail Parker, Erin Czaja, Christopher A Johnston, Helen Basiliere, Elizabeth Meek, James Olson, Danyel M Fridkin, Scott Wilson, Lucy E Perlmutter, Rebecca Holzbauer, Stacy D’Heilly, Paige Phipps, Erin Flores, Kristina Dumyati, Ghinwa Pierce, Rebecca Ocampo, Valerie Wilson, Christopher Watkins, Jasmine Gerding, Dale Clifford McDonald, L Open Forum Infect Dis Abstract BACKGROUND: Recent advancements in treating Clostridioides difficile infection (CDI) include therapeutics to prevent further recurrence in patients with recurrent CDI (rCDI). However, little is known about which patients are at increased risk for multiple recurrences (≥ 2 rCDI). We sought to identify predictors of multiple rCDI (mrCDI) in adults at the time of presentation with initial CDI (iCDI). METHODS: The Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) conducts population-based CDI surveillance in 10 U.S. sites. We defined iCDI as a positive C. difficile test during January 2018–August 2019 in a person aged ≥ 18 years with no prior positive test reported to EIP. rCDI was defined as a positive test ≥ 14 days from the previous positive test within 180 days after iCDI. All patients with community-onset iCDI and a random sample of patients with healthcare-facility onset iCDI (i.e., hospital-onset, long-term care facility onset) had full chart reviews. Multiple imputation was performed on missing race/ethnicity. Candidate variables determined a priori to be potentially associated with mrCDI were entered into an initial multivariable logistic regression model. Patients without mrCDI who died within 180 days of their iCDI were excluded from the model. Candidate variables with a p-value < 0.1 in the initial model were included in the final model. RESULTS: Of 18,829 patients with iCDI, 882 (4.7%) had mrCDI, ranging from 2 to 5 rCDI per patient in the 180 days following iCDI. Median time between each rCDI was 43 days (interquartile range: 27–65 days). Full charts were reviewed for 435 iCDI patients with mrCDI and 7474 iCDI patients without mrCDI. Characteristics of patients with and without mrCDI are shown in Table 1. In multivariable analysis, age ≥ 65 years, recent hospitalization, chronic hemodialysis, and recent nitrofurantoin use were significantly associated with mrCDI (Table 2). [Figure: see text] [Figure: see text] CONCLUSION: Patients with iCDI who are older, on hemodialysis, or had recent hospitalization or nitrofurantoin use may be at increased risk of mrCDI and may benefit from early use of adjunctive therapy to prevent mrCDI. If confirmed, these findings would aid in clinical decision making. DISCLOSURES: Ghinwa Dumyati, MD, Pfizer: Grant/Research Support Oxford University Press 2023-11-27 /pmc/articles/PMC10677783/ http://dx.doi.org/10.1093/ofid/ofad500.746 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Guh, Alice
Li, Rongxia
Korhonen, Lauren C
Winston, Lisa Gail
Parker, Erin
Czaja, Christopher A
Johnston, Helen
Basiliere, Elizabeth
Meek, James
Olson, Danyel M
Fridkin, Scott
Wilson, Lucy E
Perlmutter, Rebecca
Holzbauer, Stacy
D’Heilly, Paige
Phipps, Erin
Flores, Kristina
Dumyati, Ghinwa
Pierce, Rebecca
Ocampo, Valerie
Wilson, Christopher
Watkins, Jasmine
Gerding, Dale
Clifford McDonald, L
684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
title 684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
title_full 684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
title_fullStr 684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
title_full_unstemmed 684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
title_short 684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
title_sort 684. characteristics of patients with initial clostridioides difficile infection (cdi) that are associated with increased risk of multiple cdi recurrences
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677783/
http://dx.doi.org/10.1093/ofid/ofad500.746
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