Cited by 328Clostridium difficile and Clostridium perfringens researchAntibiotic Use and ResistanceBacterial Identification and Susceptibility Testing

Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review

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Abou Chakra, Claire Nour, Pepin, Jacques, Sirard, Stephanie, Valiquette, Louis·2014·PLoS ONE

Abstract

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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Authors
Abou Chakra, C. N., Pepin, J., Sirard, S., & Valiquette, L.
Affiliations
Université de Sherbrooke (CA)
Corresponding author
Valiquette, Louis
Venue
PLoS ONE
Published
2014-06-04
Volume
9
Issue
6
Pages
e98400
ISSN
1932-6203 (ISSN-L)
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
Open access
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

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