Risk Factors for Recurrence of Clostridioides difficile in Hospitalized Patients

J Infect Public Health. 2021 Nov;14(11):1642-1649. doi: 10.1016/j.jiph.2021.09.016. Epub 2021 Sep 23.


Background: Diarrhea and pseudomembranous colitis associated with Clostridioides difficile - a spore-forming anaerobic Gram-positive bacillus - is a major infection in hospitalized patients with a profound impact on clinical and economic outcomes. Recurrence (rCDI) is common and predisposes to further episodes with poor outcomes.

Method: We aimed to identify a wide range of risk factors for recurrence to guide stewardship initiatives. After ethical approval, we commenced collecting demographic and clinical data of patients older than 18 years with clinically and microbiologically confirmed C. difficile infection. Data were statistically analyzed using R software.

Results: Of 204 patients included in the analysis, 36 (18%) suffered 90-day recurrence, rCDI was higher among females (23%) compared to males (13%), overall age median (IQR) was 66 (51-77), and for rCDI cases 81 (69-86) years. Among 26 variables analyzed to evaluate their association with rCDI, prior clindamycin exposure, concurrent use of aztreonam, patients >76 years, total hospital length of stay, and LOS before diagnosis ≤7 days, WBC ≤ 9.85 × 103 at discharge were more likely to experience rCDI.

Conclusion: As identified in this analysis, patients with risk factors for rCDI could be candidates for close monitoring, a high index of suspicion, and risk mitigation interventions to avoid rCDI and improve clinical outcomes.

Keywords: Antibiotics Exposure; Clostridioides difficile; Comorbidities; Hospitalized Patients; Laboratory Findings; Recurrence; Risk Factors; Treatment regimens.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Clostridioides
  • Clostridioides difficile*
  • Clostridium Infections* / drug therapy
  • Clostridium Infections* / epidemiology
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Risk Factors


  • Anti-Bacterial Agents