Evaluation of a bedside scoring system for predicting clinical cure and recurrence of Clostridium difficile infections

Purpose. The accuracy Of a bedside scoring system, ATLAS, for predicting clinical cure and recurrence of Clostridium difficile infections (CDIs) was evaluated. Methods. A single-center retrospective medical record review was performed for symptomatic adult patients with stool assay-diagnosed CD! treated with metronidazole or vancomycin or both. Multiple logistic regression analysis was performed to assess the potential association of the ATLAS score and other potential factors on achieving cure and 90-day CDI recurrence. ATLAS scores were calculated, and risk factors for severe CDI, severe-complicated CD, decreased cure rates, and recurrence were recorded. Results. Data from 245 adult patients were assessed. ATLAS scores showed a significant inverse association with the cure rate (p = 0.009) but not with the 90-day recurrence rate (p = 0.901). The only ATLAS component to be independently associated (inversely) with cure was the concomitant use of antibiotics (p = 0.022). Metronidazole was initiated in 97% of patients, with 32% switching to oral vancomycin. Longer courses of vancomycin were associated with a higher cure rate (p = 0.0009) but not with recurrence (p = 0.170). Complicated cases were less likely to be cured (p = 0.027) and more likely to recur within 90 days (p = 0.002). Antibiotics continued after CDI treatment was associated with recurrence (p = 0.055). Conclusion. A low ATLAS score was found to correlate with higher cure rates in patients with CDI receiving metronidazole, oral vancomycin, or both. However, the score could not predict CDI recurrence.