The Society for Healthcare Epidemiology of America and Infectious Diseases Society of America (SHEA-IDSA) guidelines for the treatment of Clostridium difficile infection (CDI) recommend initial treatment of CDI based on disease severity. This severity definition has not been validated or evaluated based on clinical outcomes. The ATLAS scoring system is a validated tool useful in predicting treatment response and mortality in CDI. The main purpose of this study is to evaluate the concordance of the ATLAS scoring system and the SHEA-IDSA staging for CDI severity.
This was a retrospective study which included hospitalized patients with confirmed CDI. Bivariate analyses compared baseline demographics and clinical information between patients with nonsevere and severe CDI based on the SHEA-IDSA criteria for CDI severity. Kappa scores were calculated to compare the concordance of the two scoring systems in defining CDI severity. Sensitivity and specificity of the ATLAS scoring system to determine CDI severity were calculated using the SHEA-IDSA criteria as the reference standard.
Sixty-four patients met inclusion criteria. Of those, 62.5 % were classified as mild to moderate CDI, 25 % were severe, uncomplicated, and 12.5 % were severe, complicated based on SHEA-IDSA criteria. In the bivariate analyses, ATLAS score breakpoints of ≥4, ≥5, and ≥6 revealed moderate agreement with the SHEA-IDSA classification for severity. The sensitivities and specificities for ATLAS scores in predicting CDI severity ranged from 58.3 to 87.5, and 67.5–87.5 %, respectively.
The ATLAS score may be useful in evaluating CDI severity and determining drug therapy selection.
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Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431–55.
McDonald LC, Owings M, Jernigan DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis. 2006;12(3):409–15.
Miller MA, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, et al. Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy. BMC Infect Dis. 2013;13:148.
Shah D, Dang MD, Hasbun R, Koo HL, Jiang ZD, DuPont HL, et al. Clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance. Expert Rev Anti Infect Ther. 2010;8(5):555–64.
Miller M, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, et al. Correlation of the ATLAS bedside scoring system and its components with cure and recurrence of Clostridium difficile infection (CDI). 50th interscience conference on antimicrobial agents and chemotherapy (ICAAC). Boston, MA; September 12–15, 2010 (abstract K1692).
Chopra T, Miller M, Severson R, Marchaim D, Kaye KS, Alangaden G. ATLAS-A bedside scoring system –predicting mortality due to Clostridium difficile infection (CDI) in elderly hospitalized patients. 48th Annual Meeting of the Infectious Diseases Society of America (IDSA). Vancouver, BC; October 21–24, 2010 (abstract 452).
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.
Khanafer N, Touré A, Chambrier C, Cour M, Reverdy M, Argaud L, et al. Predictors of Clostridium difficile infection severity in patients hospitalised in medical intensive care. World J Gastroenterol. 2013;19(44):8034–41.
Hensgens M, Dekkers OM, Goorhuis A, LeCessie S, Kuijper EJ. Predicting a complicated course of Clostridium difficile infection at the bedside. Clin Microbiol Infect. 2014;20(5):O301–8.
Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45(3):302–7.
Conflict of interest
Dr. Hansen has received research and consulting support from Novartis and Daiichi Sankyo and has served as an expert witness for drug safety-related matters for Allergan and Boehringer Ingelheim.
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Mulherin, D.W., Hutchison, A.M., Thomas, G.J. et al. Concordance of the SHEA-IDSA severity classification for Clostridium difficile infection and the ATLAS bedside scoring system in hospitalized adult patients. Infection 42, 999–1005 (2014). https://doi.org/10.1007/s15010-014-0671-8