Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study

Jacek Czepiel, Marcela Krutova, Assaf Mizrahi, Nagham Khanafer, David A Enoch, Márta Patyi, Aleksander Deptuła, Antonella Agodi, Xavier Nuvials, Hanna Pituch, Małgorzata Wójcik-Bugajska, Iwona Filipczak-Bryniarska, Bartosz Brzozowski, Marcin Krzanowski, Katarzyna Konturek, Marcin Fedewicz, Mateusz Michalak, Lorra Monpierre, Philippe Vanhems, Theodore Gouliouris, Artur Jurczyszyn, Sarah Goldman-Mazur, Dorota Wultańska, Ed J Kuijper, Jan Skupień, Grażyna Biesiada, Aleksander Garlicki, Jacek Czepiel, Marcela Krutova, Assaf Mizrahi, Nagham Khanafer, David A Enoch, Márta Patyi, Aleksander Deptuła, Antonella Agodi, Xavier Nuvials, Hanna Pituch, Małgorzata Wójcik-Bugajska, Iwona Filipczak-Bryniarska, Bartosz Brzozowski, Marcin Krzanowski, Katarzyna Konturek, Marcin Fedewicz, Mateusz Michalak, Lorra Monpierre, Philippe Vanhems, Theodore Gouliouris, Artur Jurczyszyn, Sarah Goldman-Mazur, Dorota Wultańska, Ed J Kuijper, Jan Skupień, Grażyna Biesiada, Aleksander Garlicki

Abstract

We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome.

Keywords: Clostridioides difficile infection; co–morbidities; malignancy; mortality; outcome; risk factors.

Conflict of interest statement

The authors declare no conflict of interest.

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