Abstract
One of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore Clostridium difficile (C. difficile). The aim of this study was to retrospectively assess mortality due to C. difficile infection (CDI) in patients treated for pneumonia. We identified 94 cases of post-pneumonia CDI out of the 217 patients with CDI. The mortality issue was addressed by creating a mortality risk models using logistic regression and multivariate fractional polynomial analysis. The patients’ demographics, clinical features, and laboratory results were taken into consideration. To estimate the influence of the preceding respiratory infection, a pneumonia severity scale was included in the analysis. The analysis showed two statistically significant and clinically relevant mortality models. The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease. In conclusion, we report on two prognostic models, based on clinically relevant factors, which can be of help in predicting mortality risk in C. difficile infection, secondary to the antibiotic treatment of pneumonia. These models could be useful in preventive tailoring of individual therapy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bagdasarian N, Krishna R, Preeti NM (2015) Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 313(4):398–408
Becerra MB, Becerra BJ, Banta JE, Safdar N (2015) Impact of Clostridium difficile infection among pneumonia and urinary tract infection hospitalization: an analysis of the Nationwide Inpatient Sample. BMC Infect Dis 15:254
Di X, Bai N, Zhang X, Liu B, Ni W, Wang J, Wang K, Liang B, Liu Y, Wang R (2015) A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity. Braz J Infect Dis 19(4):339–349
Dubberke ER, Butler AM, Reske KA, Agniel D, Olsen MA, D’Angelo G, McDonald LC, Fraser VJ (2008) Attributable outcomes of endemic Clostridium difficile–associated disease in nonsurgical patients. Emerg Infect Dis 14(7):1031–1038
Gabriel L, Beriot-Mathiot A (2014) Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review. J Hosp Infect 88(1):12–21
Goudarzi M, Seyedjavadi SS, Goudarzi H, Mehdizadeh Aghdam E, Nazeri S (2014) Clostridium difficile infection: epidemiology, pathogenesis, risk factors, and therapeutic options. Scientifica (Cairo) 2014:916826. doi:10.1155/2014/916826
Habayeb H, Sajin B, Patel K, Grundy C, Al-Dujaili A, Van de Velde S (2015) Amoxicillin plus temocillin as an alternative empiric therapy for the treatment of severe hospital-acquired pneumonia: results from a retrospective audit. Eur J Clin Microbiol Infect Dis 34(8):1693–1699
Hosmer DW Jr, Lemeshow S, Sturdivant RX (2004) Applied logistic regression, 3rd edn. Wiley, Hoboken. ISBN 978-0-470-58247-3
Jawa RS, Mercer DW (2012) Clostridium difficile–associated infection: a disease of varying severity. Am J Surg 204(6):836–842
Johnson S (2009) Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 58(6):403–410
Kelly CP, LaMont JT (2008) Clostridium difficile – more difficult than ever. N Engl J Med 359(18):1932–1940
Kelly CP, Pothoulakis C, LaMont JT (1994) Clostridium difficile colitis. N Engl J Med 330(4):257–262
Khanna S, Pardi DS (2010) The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Rev Gastroenterol Hepatol 4(4):409–416
Kuy S, Jenkins P, Romero RA, Samra N, Kuy S (2016) Increasing incidence of and increased mortality associated with Clostridium difficile-associated megacolon. JAMA Surg 151(1):85–86
Monot M, Eckert C, Lemire A, Hamiot A, Dubois T, Tessier C, Dumoulard B, Hamel B, Petit A, Lalande V, Ma L, Bouchier C, Barbut F, Dupuy B (2015) Clostridium difficile: new insights into the evolution of the pathogenicity locus. Sci Rep 5:15023. doi:10.1038/srep15023
Nathwani D, Cornely OA, Van Engen AK, Odufowora-Sita O, Retsa P, Odeyemi IA (2014) Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection. J Antimicrob Chemother 69(11):2901–2912
Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Shaheen NJ (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143(5):1179–1187
Pépin J, Saheb N, Coulombe MA, Alary ME, Corriveau MP, Authier S, Leblanc M, Rivard G, Bettez M, Primeau V, Nguyen M, Jacob CE, Lanthier L (2005) Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 41(9):1254–1260
Polgreen PM, Chen YY, Cavanaugh JE, Ward M, Coffman S, Hornick DB, Diekema DJ, Herwaldt LA (2007) An outbreak of severe Clostridium difficile–associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia. Infect Control Hosp Epidemiol 28(2):212–214
Ratner B (2011) Statistical and machine-learning data mining: techniques for better predictive modeling and analysis of big data, 2nd edn. CRC Press Book, Boca Raton. ISBN 9781439860915
Royston P, Altman DG (2010) Visualizing and assessing discrimination in the logistic regression model. Stat Med 29(24):2508–2520
Sauerbrei W, Royston P (1999) Building multivariable prognostic and diagnostic models: transformation of the predictors by using fractional polynomials. J R Stat Soc Ser A Stat Soc 162:71–94
Silverman MS, Davis I, Pillai DR (2010) Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clin Gastroenterol Hepatol 8(5):471–473
Sun X, Hirota SA (2015) The roles of host and pathogen factors and the innate immune response in the pathogenesis of Clostridium difficile infection. Mol Immunol 63(2):193–202
Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland LV, Mellow M, Zuckerbraun BS (2013) Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 108(4):478–498
Zilberberg MD, Shorr AF, Kollef MH (2008) Increase in adult Clostridium difficile–related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis 14(6):929
Conflicts of Interest
The authors had no conflicts of interest to declare in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Chmielewska, M. et al. (2016). Clostridium Difficile Infection Due to Pneumonia Treatment: Mortality Risk Models. In: Pokorski, M. (eds) Pathobiology of Pulmonary Disorders. Advances in Experimental Medicine and Biology(), vol 955. Springer, Cham. https://doi.org/10.1007/5584_2016_160
Download citation
DOI: https://doi.org/10.1007/5584_2016_160
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49294-0
Online ISBN: 978-3-319-49295-7
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)