Predictors of 30-day All-cause Mortality in Veterans with First Recurrence of Clostridium difficile Infection (CDI)

BACKGROUND: Recurrent CDI is an important cause of mortality, however few studies have evaluated independent predictors of mortality in patients with recurrent CDI. METHODS: We conducted a case–control study nested in a national cohort of adult Veterans with a CDI episode (defined as a positive stool sample for C. difficile toxin(s) & receipt of >2 days of CDI treatment [IV or PO metronidazole, PO or PR vancomycin, or fidaxomicin]) during an inpatient admission or outpatient encounter at a Veterans Affairs facility from 2010–2014. Only patients with a first recurrence were included, defined as a subsequent CDI episode within 30 days from the end of treatment of the first CDI occurrence. Cases were those that experienced 30-day all-cause mortality and controls included survivors matched to cases on year of episode, facility, and severity. Multivariable conditional logistic regression was used to identify predictors of mortality. RESULTS: 110 cases were matched to 440 controls (1:4). Five predictors of mortality were identified including concurrent use of any antibiotic (OR 4.61, 95% CI 2.45–8.69), pulmonary heart disease (OR 4.707, 95% CI 1.30–17.06), the use of proton pump inhibitors within 7 days prior to CDI treatment (OR 3.59, 95% CI 2.01–6.42), nutrition deficiency (OR 2.62, 95% CI 1.28–5.38) and age (OR 1.04, 95% CI 1.02–1.07). CONCLUSION: Increasing age, proton pump inhibitors, previous antibiotic exposure, and underlying comorbidities were important predictors of death among those with first recurrence of CDI. Our data is among the first to investigate predictors of morality in patients with first recurrence, and these data may assist healthcare providers in optimizing patient care. DISCLOSURES: H. Morrill, The University of Rhode Island: Investigator, Research grant; A. Caffrey, Merck: Grant Investigator, Research grant; The Medicines Company: Grant Investigator, Research grant; Pfizer: Grant Investigator, Research grant; K. LaPlante, Merck: Grant Investigator, Grant recipient; Pfizer: Grant Investigator, Grant recipient; Cempra: Scientific Advisor, Consulting fee; The Medicines Company: Grant Investigator, Grant recipient; Allergan: Scientific Advisor, Consulting fee; Bard/ Davol: Scientific Advisor, Consulting fee; Ocean Spray: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Zavante: Scientific Advisor, Consulting fee; Achaogen: Scientific Advisor, Consulting fee