Risk factors and treatment outcomes of severe Clostridioides difficile infection in Singapore

Abstract Severe Clostridioides difficile infection (CDI) is associated with poorer outcomes. We aimed to identify risk factors and treatment outcomes of severe CDI. This was a retrospective cohort study. Eligible patients from January to December 2012 were recruited. Severity definitions were in accordance with SHEA/IDSA 2010 guideline. Treatment outcomes were (1) diarrhoea persistence, (2) CDI recurrence, (3) major complications despite treatment and (4) 30-day mortality. Two hundred and seventy-two patients were included and 40% had severe CDI. High APACHE II score (aOR 1.112, 95% CI 1.014–1.219; p < 0.05), high C-reactive protein (aOR 1.011; 95% CI 1.004–1.019; p < 0.01) and carbapenem usage in past 90 days (aOR 3.259; 95% CI 1.105–9.609; p < 0.05) were independent risk factors of severe CDI. Majority received oral metronidazole as sole treatment (92.6% for mild-moderate, 83.9% for severe, 77% for severe-complicated). Diarrhoea persistence was 32% versus 50% (p < 0.01), CDI recurrence 16.6% versus 16.5% (p > 0.05), major complications 1.2% versus 11% (p < 0.001) and 30-day mortality 7.4% versus 20.2% (p < 0.01) in mild-moderate CDI and severe CDI groups respectively. Oral metronidazole for severe CDI was associated with persistent diarrhoea, major complications and mortality. Risk factors for severe CDI can guide doctors in diagnosing severe CDI earlier and instituting oral vancomycin treatment to improve outcomes from severe CDI.

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Risk factors and prognosis of hypoalbuminemia in surgical septic patients

PeerJ ◽

10.7717/peerj.1267 ◽

2015 ◽

Vol 3 ◽

pp. e1267 ◽

Cited By ~ 5

Author(s):

Jia-Kui Sun ◽

Fang Sun ◽

Xiang Wang ◽

Shou-Tao Yuan ◽

Shu-Yun Zheng ◽

...

Keyword(s):

Risk Factors ◽

Blood Lactate ◽

Early Stage ◽

Albumin Level ◽

Multiple Organ ◽

Apache Ii ◽

Apache Ii Score ◽

Reactive Protein ◽

Retrospective Clinical Study ◽

Independent Risk Factors

The aim of this study was to investigate the risk factors of hypoalbuminemia and effects of different albumin levels on the prognosis of surgical septic patients. We preformed a retrospective clinical study including 135 adult patients from September 2011 to June 2014. The albumin levels and severity markers were recorded during the first 48 h after enrollment, and logistic regression analyses were used to determine the risk factors. The outcomes of patients with different albumin levels were also compared. The acute physiology and chronic health evaluation II (APACHE II) score (OR 1.786, 95% CI [1.379–2.314],P< 0.001), C-reactive protein (CRP) (OR 1.016, 95% CI [1.005–1.027],P= 0.005), and blood lactate (OR 1.764, 95% CI [1.141–2.726],P= 0.011) were established as the independent risk factors of hypoalbuminemia in patients with surgical sepsis. The severity markers and outcomes of patients with albumin levels ≤20 g/L were significantly worse than that of 21–25 g/L and ≥26 g/L, whereas the latter two groups had similar prognosis. Every 1 g/L decrease of albumin level below the optimal cut-off (23 g/L) was associated with a 19.4% increase in hospital mortality and a 28.7% increase in the incidence of multiple organ dysfunction syndrome. In conclusion, APACHE II score (≥14.5), CRP (≥34.25 mg/L), and blood lactate (≥.35 mmol/L) were established as the independent risk factors of hypoalbuminemia in the early stage of surgical sepsis. Patients with baseline albumin level ≤20 g/L had worse prognosis than that of albumin level ≥21 g/L. Albumin levels were negatively correlated the prognosis of surgical sepsis when below about 23 g/L.

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Advanced age and increased CRP concentration are independent risk factors associated with Clostridioides difficile infection mortality

Scientific Reports ◽

10.1038/s41598-020-71466-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Agnieszka Bednarska ◽

Dominik Bursa ◽

Regina Podlasin ◽

Marcin Paciorek ◽

Agata Skrzat-Klapaczyńska ◽

...

Keyword(s):

Risk Factors ◽

Infectious Diseases ◽

Advanced Age ◽

Receiver Operating Curve ◽

Multivariate Logistic Regression Model ◽

Risk Of Death ◽

Clostridioides Difficile ◽

Increased Risk ◽

Clostridioides Difficile Infection ◽

Independent Risk Factors

Abstract Clostridioides difficile (C.difficile) is a Gram-positive, spore-forming, toxin-producing anaerobic bacillus, which is one of the most common causes of health-care-associated infection developed mainly by elderly patients. The objective of this study was to assess mortality among the patients of the Hospital for Infectious Diseases in Warsaw related to C.difficile infection. Analysis was conducted of 1638 records reporting the medical histories of patients hospitalized for the first time due to Clostridioides difficile infection (CDI) in the Hospital for Infectious Diseases in Warsaw from 2010 to 2017. The inclusion criteria were any (principal or secondary) discharge diagnosis code for CDI according to ICD-10 and being an adult (≥ 18 years). 108 out of 1638 (7%) of the patients died. The median age in this group was 83 years. The largest number of deaths (90%) occurred in the group of patients aged 65 years or older and 81–90 years old (53% of all the deaths). In the multivariate logistic regression model relevant only to the age groups, not to sepsis—age over 80 and over 90 were independent predictors of death, increasing the risk of death by 3.4 and 1.8 times, respectively. The result of the receiver operating curve (ROC) analysis determined the age of 77 years as the threshold value, indicating the increased risk of death (AUC 0.727, standard error 0.025, 95% CI 0.678–0.776, p < 0.0001). In addition, other quantitative variables, namely CRP, creatinine and leucocytes were studied and turned out to be independent death predictors as well. The diagnosis of sepsis increased the risk of death fourfold (OR = 4.042; 95% Cl 2.4–6.7; p < 0.001). Increased inflammatory parameters, namely CRP and white blood cell count, advanced age, particularly over the age of 80, as well as a diagnosis of sepsis are independent risk factors for death and could be used as predictive markers of poor outcome in CDI.

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Risk factors for development of initial Clostridioides difficile infection

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2021.02.012 ◽

2021 ◽

Vol 25 ◽

pp. 18-22

Author(s):

Jamie L. Wagner ◽

Kayla R. Stover ◽

Allison M. Bell ◽

Katie E. Barber

Keyword(s):

Risk Factors ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

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Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

International Surgery ◽

10.9738/intsurg-d-15-00180.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 578-584

Author(s):

Fatih Ciftci ◽

Fazilet Erözgen

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Postoperative Period ◽

Perforated Peptic Ulcer ◽

Apache Ii ◽

Morbidity And Mortality ◽

Apache Ii Score ◽

Peptic Ulcers ◽

Presentation Time ◽

Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

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Hyperglycemia, hyperadiposity and leukocytosis are independent risk factors for higher serum C‐reactive protein in free‐living adults

The FASEB Journal ◽

10.1096/fasebj.26.1_supplement.819.23 ◽

2012 ◽

Vol 26 (S1) ◽

Author(s):

Fernando Moreto ◽

Rodrigo Minoru Manda ◽

Gabriel Augusto Torezan ◽

Okesley Teixeira ◽

Roberto Carlos Burini

Keyword(s):

Risk Factors ◽

C Reactive Protein ◽

Free Living ◽

Reactive Protein ◽

Independent Risk Factors

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Identification of RAGE and OSM as new prognosis biomarkers of severe pneumonia

10.21203/rs.3.rs-21370/v1 ◽

2020 ◽

Author(s):

Li Wang ◽

Yan Tan ◽

Jiangnan Zhao ◽

Lin Gao ◽

Jing Lei ◽

...

Keyword(s):

Risk Factors ◽

Oxygenation Index ◽

Severe Pneumonia ◽

Final Analysis ◽

Apache Ii Score ◽

Reactive Protein ◽

Related Risk ◽

Diabetes Mellitus Status ◽

Jinling Hospital ◽

Risk Patients

Abstract BackgroundPatients with severe pneumonia complicated with hypoxic respiratory failure often associated with increased morbidity and mortality rates. It is critical to discover more sensitive and specific markers for early identification of such high risk patients thus specific and timely treatment can be adjusted.MethodsThis retrospective study was performed in the respiratory intensive care unit (RICU) of Nanjing First Hospital and Jinling Hospital, Nanjing Medical University. Clinical data of patients admitted to the RICU and diagnosed with pneumonia from January 2017 to October 2019 was retrospectively reviewed. The eligible patients were classified into hypoxemia and non hypoxemia groups according to oxygenation index of 250 mmHg. In the meantime, the same cohort was separated into survival and deceased groups after 30 days post hospital admission. The related risk factors in these two classifications were examined separately.ResultsA total of 828 patients were screened for eligibility, and eventually 130 patients with pneumonia were included in our final analysis. Among the patients, 16 passed away despite exhausting standard treatments. The comparison between hypoxemia and non hypoxemia groups suggested that gender, diabetes mellitus status, count of white blood cell(WBC), neutrophils, neutrophils/Lymphocyte, lactic acid, creatinine, D-dimer, procalcitonin (PCT), C-reactive protein (CRP), PH, Lymphocyte, albumin and RAGE were significantly different.ConclusionsPrevious studies have suggested that the APACHE II score, LIS, SOFA, Nutric scores, WBC, neutrophils, lymphocyte counts and albumin levels were independent risk factors for severe pneumonia. Our study indicated that RAGE should be a new biomarker to predict poor prognosis in pneumonia. In addition, we also showed that LIS, SOFA, lactate, lymphocyte, platelet, BUN, total bilirubin, and PCT levels before treatment were independent factors that associated with 30 days survival rate. In addition, we proposed that OSM should be considered as a new prognosis marker for pneumonia patients.

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1498. Assess Risk Factors, Mortality, and Healthcare Utilization Associated with Clostridioides difficile Infection (CDI) in 4 Latin American Countries

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1362 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S545-S545

Author(s):

Holly Yu ◽

Nestor Flaster ◽

Adrian Casanello ◽

Daniel Curcio

Keyword(s):

Risk Factors ◽

Latin America ◽

Hospital Admission ◽

Healthcare Utilization ◽

Latin American ◽

Conditional Logistic Regression ◽

Developed Countries ◽

Hospital Death ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

Abstract Background In contrast to Europe and North America, little is known about Clostridioides difficile infection (CDI) in Latin America, especially about risk factors, mortality, and healthcare utilization. Methods We conducted a retrospective, case–control study at eight hospital centers in Brazil, Mexico, Argentina, and Chile. Hospital databases and medical records were used to identify nosocomial CDI cases from January 1, 2014 to December 31, 2017. CDI cases were patients with diarrhea and a positive CDI testing ≥72 hours after hospital admission. Two controls with no CDI diagnosis and diarrhea were matched to each CDI case and were required to (1) have a length of hospital stay (LOS) ≥ 3 days, (2) be admitted ±14 days from the case, and (3) share the same ward. Risk factors associated with CDI were assessed by conditional logistic regression. Mortality and healthcare utilization were compared between cases and controls. Results A total of 1,443 patients (≥18 years old) who met eligibility criteria were selected (481 cases and 962 controls). Comparing cases to controls, the mean age and gender representation were similar (age: 58.7 vs. 56.7 years, P = 0.269; male: 56.3% vs. 53.4%, P = 0.293), but comorbidity was higher (mean Charlson Comorbidity index: 4.3 vs. 3.6, p Conclusion Antibiotic exposure, existing medical conditions, and recent hospital admission are CDI major risk factors in Latin America. CDI also increased in-hospital death risk and LOS. These findings are consistent with published literature in developed countries. Disclosures All authors: No reported disclosures.

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