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A new score to predict Clostridioides difficile infection in medical patients: a sub-analysis of the FADOI-PRACTICE study

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Abstract

Medical divisions are at high risk of Clostridioides difficile infection (CDI) due to patients’ frailty and complexity. This sub-analysis of the FADOI-PRACTICE study included patients presenting with diarrhea either at admission or during hospitalization. CDI diagnosis was confirmed when both enzyme immunoassay and A and B toxin detection were found positive. The aim of this sub-analysis was the identification of a new score to predict CDI in hospitalized, medical patients. Five hundred and seventy-two patients with diarrhea were considered. More than half of patients was female, 40% on antibiotics in the previous 4 weeks and 60% on proton pump inhibitors (PPIs). CDI diagnosis occurred in 103 patients (18%). Patients diagnosed with CDI were older, more frequently of female sex, recently hospitalized and bed-ridden, and treated with antibiotics and PPIs. Through a backward stepwise logistic regression model, age > 65 years, female sex, recent hospitalization, recent antibiotic therapy, active cancer, prolonged hospital stay (> 12 days), hypoalbuminemia (albumin < 3 g/dL), and leukocytosis (white blood cells > 9 × 10^9/L) were found to independently predict CDI occurrence. These variables contributed to building a clinical prognostic score with a good sensitivity and a modest specificity for a value > 3 (79% and 58%, respectively; AUC 0.75, 95% CI 0.71–0.79, p < 0.001), that identified low-risk (score ≤ 3; 42.5%) and high-risk (score > 3; 57.5%) patients. Although some classical risk factors were confirmed to increase CDI occurrence, the changing landscape of CDI epidemiology suggests a reappraisal of common risk factors and the development of novel risk scores based on local epidemiology.

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Data availability statement

The datasets analyzed during the current study are available from the corresponding Author upon reasonable request.

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Acknowledgment

This manuscript was developed during the “Writing Weekend” meeting organized by FADOI.

Funding

The FADOI-PRACTICE study was supported by a research grant from Astellas Pharma Italy, without any involvement in the design of the study and collection, analysis and interpretation of data and writing of the manuscript.

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Author notes

  1. Nicola Mumoli and Aldo Bonaventura have equally contributed as first authors.

Authors and Affiliations

  1. Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, MI, Italy

    Nicola Mumoli

  2. Department of Internal Medicine, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy

    Aldo Bonaventura

  3. Department of Internal Medicine, Legnano Hospital, ASST Ovest Milanese, Legnano, MI, Italy

    Chiara Marchesi & Antonino Mazzone

  4. Department of Internal Medicine, Cecina Hospital, Cecina, LI, Italy

    Marco Cei

  5. Department of Internal Medicine, Senigallia Hospital, Senigallia, AN, Italy

    Laura Morbidoni

  6. Department of Internal Medicine, Salerno Hospital, Salerno, Italy

    Iginio Donatiello

  7. Department of Medicine and Surgery, Insubria University, Varese, Italy

    Francesco Dentali

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  1. Nicola Mumoli
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  2. Aldo Bonaventura
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  3. Chiara Marchesi
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  8. Francesco Dentali
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Corresponding author

Correspondence to Nicola Mumoli.

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Conflict of interest

Aldo Bonaventura received honoraria from Effetti s.r.l. (Milan, Italy) to collaborate on the medical website www.inflammology.org, outside the present work. The other authors have nothing to disclose.

Human and animal rights

This observational prospective multicenter study was conducted in conformity with the Good Clinical Practice Guidelines of the Italian Ministry of Health and the ethical guidelines of the Declaration of Helsinki (as revised and amended in 2004) following the IRB approval of each participating center.

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An informed consent has been obtained from each enrolled patient.

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Mumoli, N., Bonaventura, A., Marchesi, C. et al. A new score to predict Clostridioides difficile infection in medical patients: a sub-analysis of the FADOI-PRACTICE study. Intern Emerg Med 18, 2003–2009 (2023). https://doi.org/10.1007/s11739-023-03395-5

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