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Factors Predicting Recurrence of Clostridium difficile Infection (CDI) in Hospitalized Patients
  1. Mohamed Abdelfatah, MD*,
  2. Rabih Nayfe, MD*,
  3. Ala Nijim, MD*,
  4. Kathleen Enriquez, MD*,
  5. Eslam Ali, MD,
  6. Richard R. Watkins, MD, MS‡§,
  7. Hossam Kandil, MD, PhD
  1. From the *Department of Medicine, Akron General Medical Center, Cleveland Clinic Affiliate, Akron; †Division of Gastroenterology and Hepatology, East Carolina University, Greenville; ‡Division of Infectious Diseases, Akron General Medical Center, Akron; and §Department of Medicine, Northeast Ohio Medical University, Rootstown, OH.
  1. Received November 13, 2014, and in revised form January 13, 2015.
  2. Accepted for publication January 22, 2015.
  3. Reprints: Mohamed Abdelfatah, MD, 1st Akron General Ave, Akron, OH 44307. E-mail: Mohamed.Abdelfatah{at}

Retrospective Study of More Than 2000 Patients


Background Clostridium difficile infection (CDI) has increased in incidence and severity worldwide, causing direct costs estimated to range from US $3.2 billion to $4.8 billion. The aim of this study was to investigate and identify factors that predict recurrence of CDI.

Methods This was a retrospective case-control study between 2007 and 2013 on patients admitted with CDI. Recurrent CDI is defined as a new episode of diarrhea within 90 days confirmed by a positive stool C. difficile toxin assay or polymerase chain reaction, after resolution of the initial CDI episode for at least 10 days and after discontinuation of the CDI therapy.

Results Three thousand twenty patients were diagnosed with CDI between January 2007 and December 2013. Two hundred nine of 2019 patients in the study had a recurrence of CDI within 90 days of the end of the initial CDI episode (10.3%). Multivariate analysis showed that most of the recurrences occurred in patients with comorbidities, particularly chronic kidney disease (odds ratio, 1.3; 95% confidence interval [CI], 1.0–2.4; P = 0.039). In addition, a higher percentage of patients in the recurrence group were prescribed proton-pump inhibitors (odds ratio, 1.65; 95% CI, 1.0–1.7; P = 0.002) and steroids (odds ratio, 1.65; 95% CI, 1.0–1.5; P = 0.047).

Conclusions Our data suggest that the use of glucocorticoids, use of proton-pump inhibitors, and having end-stage renal disease are significant risk factors associated with recurrent CDI.

Key Words
  • Clostridium difficile infection (CDI)
  • recurrent Clostridium difficile infection
  • statins
  • proton-pump inhibitors
  • antidepressants, steroids
  • renal disease
  • nursing home
  • diarrhea
  • CDI

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