Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review
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BACKGROUND: Clostridium difficile infection (CDI) can lead to complications, recurrence, and death. Numerous studies have assessed risk factors for these unfavourable outcomes, but systematic reviews or meta-analyses published so far were limited in scope or in quality. METHODS: A systematic review was completed according to PRISMA guidelines. An electronic search in five databases was performed. Studies published until October 2013 were included if risk factors for at least one CDI outcome were assessed with multivariate analyses. RESULTS: 68 studies were included: 24 assessed risk factors for recurrence, 18 for complicated CDI, 8 for treatment failure, and 30 for mortality. Most studies accounted for mortality in the definition of complicated CDI. Important variables were inconsistently reported, such as previous episodes and use of antibiotics. Substantial heterogeneity and methodological limitations were noted, mainly in the sample size, the definition of the outcomes and periods of follow-up, precluding a meta-analysis. Older age, use of antibiotics after diagnosis, use of proton pump inhibitors, and strain type were the most frequent risk factors for recurrence. Older age, leucocytosis, renal failure and co-morbidities were frequent risk factors for complicated CDI. When considered alone, mortality was associated with age, co-morbidities, hypo-albuminemia, leucocytosis, acute renal failure, and infection with ribotype 027. CONCLUSION: Laboratory parameters currently used in European and American guidelines to define patients at risk of a complicated CDI are adequate. Strategies for the management of CDI should be tailored according to the age of the patient, biological markers of severity, and underlying co-morbidities.
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Antibiotics and chemotherapeutic agents disrupt microbiota-mediated colonization resistance and allow C. difficile to establish in the intestines.
“However, a variety of risk factors including exposure to antibiotics and chemotherapeutic agents disrupt microbiota-mediated colonization resistance and allow C. difficile to take hold in the intestines (Abou Chakra et al., 2014).”
From The Impact of Dietary Transition Metals on Host-Bacterial Interactions (2018) · cites this paper as Abou Chakra et al., 2014
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Effect of ribotype on all-cause mortality following Clostridium difficile infection
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Reducing the Risk of Severe Complications among Patients withClostridium difficileInfection
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Vitamin D Status and Severity of Clostridium difficile Infections
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Lymphopenia as a novel marker of Clostridium difficile infection recurrence
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McDonald, L. C., Gerding, D. N., Johnson, S., Bakken, J. S., Carroll, K. C., Coffin, S. E., Dubberke, E. R., Garey, K. W., Gould, C. V., Kelly, C., et al. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/cix1085 · Cited by 2,690 · see citing works
The Impact of Dietary Transition Metals on Host-Bacterial Interactions
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Fernandez-Cotarelo, M.-J., Nagy-Agren, S. E., Smolkin, M. E., Jimenez-Diez-Canseco, L., Perez-Pomata, M.-T., Shenal, B. V., & Warren, C. A. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04935-6 · Cited by 13 · see citing works
- Authors
- Abou Chakra, C. N., Pepin, J., Sirard, S., & Valiquette, L.
- Affiliations
- Université de Sherbrooke (CA)
- Corresponding author
- Valiquette, Louis
- ORCID
- Valiquette, Louis
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-06-04
- Volume
- 9
- Issue
- 6
- Pages
- e98400
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4045753
- OpenAlex
- W1969144992
- Cited by
- 328
- References
- 110
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 19 · 2023: 21 · 2022: 26 · 2021: 23 · 2020: 34 · 2019: 38 · 2018: 35 · 2017: 36 · 2016: 30 · 2015: 31 · 2014: 6
- FWCI
- 4.77
- Type
- journal article
- Language
- en
- Update notices
- correction (2014-08-28)
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- Clostridium difficile infection, recurrence, complicated infections, mortality, risk factors, antibiotic use, proton pump inhibitors, ribotype 027, leukocytosis, hypoalbuminemia, acute kidney injury, comorbidities, age, treatment failure
- MeSH terms
- Age Factors, Enterocolitis, Pseudomembranous, Humans, Recurrence, Risk Factors, Clostridioides difficile, Treatment Failure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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