Risk factors of the Clostridium difficile infection in patients with chronic kidney disease

Abstract

Background: Clostridium difficile (C. difficile) is a Gram-positive bacillus responsible for diarrhea and colitis, mainly among hospitalized patients. It is a leading cause of nosocomial infections.

Objectives: The main goal of the study was to assess the risk factors of the C. difficile infection in patients with chronic kidney disease (CKD).

Material and methods: We evaluated the medical records of all patients treated at the Department of Nephrology and Renal Transplantation of the Research and Development Center in the Provincial Specialist Hospital in Wrocław, Poland, between February 2009 and May 2012, who developed diarrhea, abdominal pain and/or fever within 72 h after admission. In patients with these symptoms, an enzyme cassette immunoassay was performed to detect antigens of C. difficile toxins A and B in stool.

Results: There were 207 patients enrolled in the study, presented with the symptoms of the C. difficile infection. Out of these patients, 69 (33%) persons were positive for C. difficile toxins. Longer hospitalization time and lower initial serum albumin concentration significantly increased the risk of infection (p < 0.05). Apart from the C. difficile infection, age, the number of used antibiotics, longer hospitalization time, and lower initial serum albumin concentration significantly augmented the risk of death (p < 0.05).

Conclusions: In patients with CKD, longer hospitalization time and lower serum albumin concentration significantly increased the risk of the C. difficile infection. The C. difficile infection, age, the number of used antibiotics, longer hospitalization time, and lower initial serum albumin concentration notably augmented the risk of death. Although the incidence of the C. difficile infection did not correlate with the estimated glomerular filtration rate (eGFR), 67% of patients who tested positive were class 5 of CKD, whereas only 5.7% were class 1.

Keywords: Clostridium difficile; chronic renal insufficiency; malnutrition; pseudomembranous enterocolitis.