A Hospital-Based Study on Risk Factors of Recurrent Clostridium Difficile Associated Disease in Hong Kong

BackgroundThe incidence and severity of Clostridium difficile associated disease (CDAD) is increasing worldwide. Risk factors of CDAD were identified in many studies. However, risk factors of recurrent CDAD are not well established. Local data are limited.AimThe primary objective is to determine recurrence rate and identify risk factors of recurrent CDAD. MethodsA 30-month multi-centre retrospective cohort study was conducted in three hospitals. Five hundred and seventy five patients suffering from CDAD were recruited. They were divided into recurrent and non-recurrent group. ResultsSixty five patients developed recurrent CDAD. The recurrence rate was 11.3%. Multivariate logistic regression analysis was performed. Patients taking proton pump inhibitor (PPI)(adjusted OR2.006, 95%CI 1.135-3.546,P=0.017)had significantly higher risk of recurrent CDAD. PPI use more than the World Health Organization (WHO) defined daily dose further increased the risk(adjusted OR3.573, 95%CI 1.107-11.533,P=0.033). Naso-gastric (NG) tube feeding(adjusted OR2.177, 95%CI 1.237-3.834,P=0.007)and serum albumin less than 25g/L(adjusted OR2.037, 95%CI 1.118-3.711,P=0.020)also significantly increased the risk of recurrent CDAD.ConclusionsRisk factors of recurrent CDAD included use of PPI, NG tube feeding and serum albumin less than 25g/L. PPI use more than the WHO defined daily dose further increased the risk. Judicious use of PPI and regular review on need of NG tube feeding are important measures to prevent recurrence of CDAD. Morbidity, mortality and thus burden on the health-care system might then be reduced.