A multicentre, retrospective cohort study into risk factors and outcomes for Clostridium Difficile in the Belfast Trust.

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Introduction

Studies show that the incidence of Clostridium Difficile Infection (CDI) is rising in our hospitals. This study was compiled to analyse risk factors and outcomes of CDI positive patients in the Belfast Trust over a period of 12 months (Nov 2016-Nov 2017).

Methods

Data was collected from 5 centres within the Belfast Trust totaling 85 patients. Age greater than 65 was included as a risk factor. Previous hospital admission (within 90 days of positive culture), antibiotic usage, regular Proton Pump Inhibitor use and Inflammatory Bowel Disease were recorded risk factors.

Results

Age and recent anti-microbial use were identified as major risk factors, 71.8% and 87.1% respectively. 70.6% had a recent hospital admission. PPI usage was also found to have a positive correlation to testing positive for CDI, with 48.2% of patients having used a PPI at some point preceding or during admission.

One patient in this study required surgical intervention (1.8% of cases) despite 4.7% developing Toxic Megacolon. 23.5% of the patients included in the study died during the admission, assumed at least in part, to be due to CDI.

Conclusion

Conclusions The analysis verifies the previously known risk factors: age, antibiotic use and hospital admissions. Interestingly PPI usage ranked higher than IBD and previous infection as a risk factor. This leads us to question the appropriateness of PPI use in patients with pre-existing risk factors. This would be of particular concern as the data suggests that there is nearly a 1in 4 chance of death in the event of developing CDI in hospital.