RISK-FACTORS FOR EARLY RECURRENT CLOSTRIDIUM-DIFFICILE - ASSOCIATED DIARRHEA

Recurrence is a common sequela of Clostridium difficle-associated diar rhea (CDD) and may increase morbidity, costs, and treatment-related an timicrobial resistance. Because recurrent CDD (RCDD) frequently occurs very soon after an initial episode, our goal was to determine the ris k factors for early RCDD (occurring less than or equal to 45 days afte r the initial episode). We conducted a case-control study, comparing 1 3 patients with early RCDD (case patients) with 46 patients who had on ly one CDD episode (control patients) at Centre Hospitalier Angrignon (Quebec) during January 1993 through November 1994. Risk factors for e arly RCDD included a history of chronic renal insufficiency, a white b lood cell count of greater than or equal to 15 x 10(3)/mm(3), and comm unity-acquired diarrhea with the first CDD episode. For seven of eight case patients, C. difficile strains from the first and second CDD epi sodes were identical, suggesting that relapse is more common than rein fection. These results suggest that treatments should be directed at p reventing relapses in patients at high risk for early RCDD.