About one in five patients with Clostridium difficile (C. difficile) infection will have that infection come back. Doctors have developed a simple, three-point rule that can help identify those patients most at risk for recurrence.
Patients who are most likely to have their infection return are over 65, have severe or suddenly intense symptoms, and continue other antibiotics after treatment for C. difficile infection.
Knowing which patients are likely to be in trouble can help doctors use interventions to prevent the disease from coming back,
Doctors at Beth Israel Deaconess Medical Center in Boston initially developed the rule in 63 hospitalized patients with C. difficile infection. The rule was then able to predict which of another 90 patients would experience a recurrence with about 80 percent accuracy.
Dr. Ciaran P. Kelly,lead author of the study, pointed out,
This rule is valuable in clinical practice as it defines a high-risk population in whom awareness of the risk can facilitate more prompt recognition, diagnosis and treatment of recurrent C. difficile. These patients are also most likely to benefit from interventions to prevent recurrence, such as infection control precautions, prudent use of antibiotics, prolongation of metronidazole or vancomycin therapy, and use of probiotics or other prophylactic measures.
C. difficile infection is a growing problem and the leading cause of hospital-acquired diarrhea in the world, sometimes leading to death. It causes watery diarrhea, fever, nausea, and abdominal pain. Cases tripled in the United States between 1995 and 2006.
In an accompanying editorial in Gastroenterology Christina Surawicz, M.D., a gastroenterologist at the University of Washington, discusses the importance of the rule in recognizing and developing treatment for recurrent C. difficile infection.
SOURCE: Hu et al., Gastroenterology, Volume 136, Number 4, April 2009