Prospective Derivation and Validation of a Clinical Prediction Rule for Recurrent Clostridium difficile Infection

  • M.Y. H
  • K. K
  • L. K
 et al. 
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Abstract

Background & Aims: Prevention of recurrent Clostridium difficile infection (CDI) is a substantial therapeutic challenge. A previous prospective study of 63 patients with CDI identified risk factors associated with recurrence. This study aimed to develop a prediction rule for recurrent CDI using the above derivation cohort and prospectively evaluate the performance of this rule in an independent validation cohort. Methods: The clinical prediction rule was developed by multivariate logistic regression analysis and included the following variables: age >65 years, severe or fulminant illness (by the Horn index), and additional antibiotic use after CDI therapy. A second rule combined data on serum concentrations of immunoglobulin G (IgG) against toxin A with the clinical predictors. Both rules were then evaluated prospectively in an independent cohort of 89 patients with CDI. Results: The clinical prediction rule discriminated between patients with and without recurrent CDI, with an area under the curve of the receiver-operating-characteristic curve of 0.83 (95% confidence interval [CI]: 0.70-0.95) in the derivation cohort and 0.80 (95% CI: 0.67-0.92) in the validation cohort. The rule correctly classified 77.3% (95% CI: 62.2%-88.5%) and 71.9% (95% CI: 59.2%-82.4%) of patients in the derivation and validation cohorts, respectively. The combined rule performed well in the derivation cohort but not in the validation cohort (area under the curve of the receiver-operating-characteristic curve, 0.89 vs 0.62; diagnostic accuracy, 93.8% vs 69.2%, respectively). Conclusions: We prospectively derived and validated a clinical prediction rule for recurrent CDI that is simple, reliable, and accurate and can be used to identify high-risk patients most likely to benefit from measures to prevent recurrence. 2009 AGA Institute.

Author-supplied keywords

  • *Clostridium difficile infection/dt [Drug Therapy]
  • *recurrent infection
  • aged
  • antibiotic agent/dt [Drug Therapy]
  • antibiotic therapy
  • article
  • blood sampling
  • comorbidity
  • diagnostic accuracy
  • disease duration
  • disease severity
  • enzyme linked immunosorbent assay
  • female
  • follow up
  • high risk patient
  • human
  • immunoglobulin G/ec [Endogenous Compound]
  • immunoglobulin blood level
  • immunosuppressive treatment
  • major clinical study
  • male
  • metronidazole/cb [Drug Combination]
  • metronidazole/dt [Drug Therapy]
  • prediction
  • priority journal
  • prospective study
  • reliability
  • risk assessment
  • sensitivity and specificity
  • treatment duration
  • validation study
  • vancomycin/cb [Drug Combination]
  • vancomycin/dt [Drug Therapy]

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Authors

  • Hu M.Y.

  • Katchar K.

  • Kyne L.

  • Maroo S.

  • Tummala S.

  • Dreisbach V.

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