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Czepiel J, Krutova M, Mizrahi A, Khanafer N, Enoch DA, Patyi M, Deptuła A, Agodi A, Nuvials X, Pituch H, Wójcik-Bugajska M, Filipczak-Bryniarska I, Brzozowski B, Krzanowski M, Konturek K, Fedewicz M, Michalak M, Monpierre L, Vanhems P, Gouliouris T, Jurczyszyn A, Goldman-Mazur S, Wultańska D, Kuijper EJ, Skupień J, Biesiada G, Garlicki A. Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study. Antibiotics (Basel) 2021; 10:antibiotics10030299. [PMID: 33805755 PMCID: PMC7998379 DOI: 10.3390/antibiotics10030299] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland; (G.B.); (A.G.)
- Correspondence: ; Tel./Fax: +48-124002022/17
| | - Marcela Krutova
- Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, 15006 Prague, Czech Republic; or
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
| | - Assaf Mizrahi
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France;
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, 92290 Châtenay Malabry, France
| | - Nagham Khanafer
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Unité d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, 69002 Lyon, France;
- Centre International de Recherche en Infectiologie (CIRI), Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Université de Lyon, 69372 Lyon, France
| | - David A. Enoch
- Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; (D.A.E.); (T.G.)
| | - Márta Patyi
- Hygienic Department, Bács-Kiskun County Teaching Hospital, 6000 Bács-Kiskun, Hungary;
| | - Aleksander Deptuła
- Department of Propaedeutics of Medicine and Infection Prevention, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland;
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Xavier Nuvials
- Critical Care Department, Vall d’Hebron Hospital, Vall d’Hebron Institut de Recerca (VHIR), SODIR Group, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Hanna Pituch
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Department of Medical Microbiology, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Małgorzata Wójcik-Bugajska
- Department of Internal and Geriatric Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Iwona Filipczak-Bryniarska
- Department of Pain Treatment and Palliative Care, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Bartosz Brzozowski
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Marcin Krzanowski
- Department of Nephrology and Dialysis Unit, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | | | | | | | - Lorra Monpierre
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France;
| | - Philippe Vanhems
- Unité d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, 69002 Lyon, France;
- Centre International de Recherche en Infectiologie (CIRI), Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Université de Lyon, 69372 Lyon, France
| | - Theodore Gouliouris
- Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK; (D.A.E.); (T.G.)
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.J.); (S.G.M.)
| | - Sarah Goldman-Mazur
- Department of Hematology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.J.); (S.G.M.)
| | - Dorota Wultańska
- Department of Medical Microbiology, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Ed J. Kuijper
- ESCMID Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland; (A.M.); (N.K.); (H.P.); (E.J.K.)
- Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, 2333 Leiden, The Netherlands
- Centre for Infectious Diseases Research, Diagnostics and Laboratory, Surveillance, Rijksinstituut voor Volksgezondheid en Milieu, 2333 Bilthoven, The Netherlands
| | - Jan Skupień
- Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland;
| | - Grażyna Biesiada
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland; (G.B.); (A.G.)
| | - Aleksander Garlicki
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland; (G.B.); (A.G.)
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