Clostridium difficile Infection in Immuno-compromised and Non-immunocompromised Hosts – A Single-center Experience
Sai Wah Cheung *
Department of Medicine and Geriatrics, Division of Gastroenterology and Hepatology, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong.
Wai Man Yip
Department of Medicine and Geriatrics, Division of Gastroenterology and Hepatology, Pok Oi Hospital, Yuen Long, New Territories, Hong Kong.
Lawrence Siu Wing Lai
Department of Medicine and Geriatrics, Division of Gastroenterology and Hepatology, Pok Oi Hospital, Yuen Long, New Territories, Hong Kong.
Kin Kong Li
Department of Medicine and Geriatrics, Division of Gastroenterology and Hepatology, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong.
*Author to whom correspondence should be addressed.
Abstract
Background: Clostridium difficile infection (CDI) is the most common nosocomial and antibiotic-associated diarrheal disease of different severity. Patients of immunocompromised status were observed to be particularly at risk of complications and severe disease in the Western culture; however, local clinical data in tropical or subtropical region is scarce.
Methods: We performed a retrospective review of 220 cases at the Tuen Mun Hospital in Hong Kong from May 2010 to April 2012. Independent predictors for 30-day mortality and 60-day recurrence were determined by multivariate logistic regression analysis.
Results: The mortality and recurrence were more prevalent in the immunocompromised group accounting for 36.1% (n=44) and 18.9% (n=23) respectively. We found independent associations between death and the hostel residency (odds ratio [OR], 2.33; 95% confidence interval [CI], 0.99-5.5), chronic kidney disease (OR, 2.74; 95% CI, 1.12-6.7), metronidazole treatment <10 days (OR, 2.31; 95% CI, 1.04-5.11), albumin level <30 g/L (OR, 2.31; 95% CI, 1.04-5.14) and proton pump inhibitor exposure (OR, 2.4, 95% CI 1.03-5.54). The hostel residency (OR, 2.56; 95% CI, 1.07-6.1) and duration of disease ≥ 10 days (OR, 2.55; 95% CI, 0.997-6.52) were associated with increased odds of recurrence.
Conclusions: CDI is a disease with significant morbidities, complications and mortality whereas the severity is significantly higher in the immunocompromised hosts. Shorter duration of metronidazole as an independent poor prognostic predictor was rarely reported before this paper.
Keywords: Clostridium difficile, immunocompromised, pseudomembranous colitis, proton pump inhibitor, albumin.