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  • Infection Control & Hospital Epidemiology, Volume 32, Issue 3
  • March 2011, pp. 220-228

Comparison of Clinical Severity Score Indices for Clostridium difficile Infection

  • Shigeki Fujitani (a1) (a2), W. Lance George (a3) (a4) and A. Rekha Murthy (a4) (a5)
  • DOI: http://dx.doi.org/10.1086/658336
  • Published online: 02 January 2015
Abstract
Objective.

To compare 8 severity score indices for Clostridium difficile infection (CDI).

Design.

Prospective observational study.

Methods.

This study was conducted from July through October 2006. All hospitalized patients in 3 university-affiliated hospitals with a positive fecal Clostridium difficile toxin assay result were evaluated. Infection was considered severe if patients had at least 1 of the following clinical events during their hospitalization: (1) death attributed to CDI within 30 days after diagnosis, (2) colectomy necessitated by CDI, or (3) intensive care unit admission for management of complications attributed to CDI. Severity was assessed on the basis of 8 severity score indices, using published criteria for severe CDI as the benchmark. The 8 severity score indices studied were Beth Israel, University of Pittsburgh Medical Center version 1, University of Pittsburgh Medical Center version 2, Hines VA, modified University of Illinois, University of Calgary version 1, University of Calgary version 2, and University of Temple.

Results.

Of 184 patients with CDI evaluated, 19 had severe cases and 165 had nonsevere cases, as assessed on the basis of the defined severe CDI criteria. Sensitivities of the 8 severity score indices studied ranged from 63.2% to 84.2%, and specificities ranged from 59.4% to 93.9%. The Hines VA index had the highest kappa score (0.69 [95% confidence interval, 0.54-0.83]), followed by the University of Pittsburgh Medical Center version 1 index. Independent risk factors for severe CDI determined by multivariate analysis were abdominal distention (P = .007), fever (temperature, 38.0°C or above; P = .042), white blood cell count of at least 20,000 cells/mm3 (P = .035), and hypoalbuminemia (serum albumin level less than 3 mg/dL; P = .029).

Conclusion.

The Hines VA CDI severity score index appeared to display the strongest correlation for predicting more severe forms of CDI.

Copyright
Corresponding author
St. Marianna University Hospital, 2-16-1 Sugao Miyamae-ku, Kawasaki-city, Kanagawa, Japan2168511 (shigekifujitani@hotmail.com)
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1.F Barbut , G Corthier , Y Charpak , et al.Prevalence and pathogenicity of Clostridium difficile in hospitalized patients: a French multicenter study. Arch Intern Med 1996;156:14491454.

2.JG Bartlett . Clostridium difficile, history of its role as an enteric pathogen and the current state of knowledge about the organism. Clin Infect Dis 1994;18(suppl 4):S265S272.

3.J Pepin , L Valiquette , ME Alary , et al.Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466472.

4.LC McDonald , GE Killgore , A Thompson , et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.

5.M Warny , J Pepin , A Fang , et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:10791084.

6.MS Rubin , LE Bodenstein , KC Kent . Severe Clostridium difficile colitis. Dis Colon Rectum 1995;38:350354.

7.VG Loo , L Poirier , MA Miller , et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.

8.MD Redelings , F Sondilo , L Mascola . Increase in Clostridium difficile-rehted mortality rates, United States, 1999-2004. Emerg Infect Dis 2007;13:14171419.

10.J Belmares , DN Gerding , JP Parada , S Miskevics , F Weaver , S Johnson . Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system. J Infect 2007;55:495501.

11.D Gujja , FK Friedenberg . Predictors of serious complications due to Clostridium difficile infection. Aliment Pharmacol Ther 2009;29:635642.

13.TJ Louie , J Peppe , CK Watt , et al.Tolevamer, a novel non-antibiotic polymer, compared with vancomycin in the treatment of mild to moderately severe Clostridium difficile-associated diarrhea. Clin Infect Dis 2006;43:411420.

14.MC McEUistrem , RJ Carman , DN Gerding , CW Genheimer , L Zheng . A hospital outbreak of Clostridium difficile disease associated with isolates carrying binary toxin genes. Clin Infect Dis 2005;40:265272.

15.FA Zar , SR Bakkanagari , KM Moorthi , MB Davis . A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302307.

16.DA Katz , ME Lynch , B Littenberg . Clinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea. Am J Med 1996;100:487495.

19.F Lamontagne , AC Labbe , O Haeck , et al.Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg 2007;245:267272.

20.TJ Henrich , D Krakower , A Bitton , DS Yokoe . Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis 2009;15:415422.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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