Risk Factors for Recurrent Clostridium difficile Infection

Background/Aims: Clostridium difficile infection (CDI) is a common nosocomial infection associated with substantial morbidity, mortality and increased medical care costs. Although most patients initially respond to therapy, with either metronidazole or vancomycin, about 15-20% of patients experience recurrence. The aim of this study was to analyze the risk factors related to recurrent CDI (RCDI). Methods: We retrospectively reviewed data, from patients diagnosed with CDI during admission at a university hospital between January 2000 and December 2006, for comparison with data from RCDI patients. Results: Among a total of 294 CDI patients, 32 (10.8%) had experienced RCDI. Risk factors for RCDI included anemia, congestive heart failure, respiratory infection, time between admission and CDI diagnosis, duration of antibiotic therapy prior to CDI diagnosis, tube feeding, and gastrointestinal endoscopy. Multivariate analysis revealed that tube feeding was associated with recurrence (odds ratio, 3.65; 95% confidence interval, 1.38-9.65; P=0.009). Conclusions: Patients who received tube feeding were at increased risk of RCDI. Targeting these patients for preventive strategies may contribute to a reduction in the incidence of RCDI.