Korean J Intern Med.  2016 Jan;31(1):125-133. 10.3904/kjim.2016.31.1.125.

Advanced chronic kidney disease: a strong risk factor for Clostridium difficile infection

• Kim SC
• Seo MY
• Lee JY
• Kim KT
• Cho E
• Kim MG
• Jo SK
• Cho WY
• Kim HK

• KMID: 2373781
• DOI: http://doi.org/10.3904/kjim.2016.31.1.125

Abstract

BACKGROUND/AIMS
It has been suggested that chronic kidney disease (CKD) is a risk factor for Clostridium difficile infection (CDI) and is associated with increased mortality among patients infected with C. difficile. However, recent studies of the clinical impact of CKD on CDI in Asians are still insufficient. We sought to determine the relationship between CKD and CDI in a Korean population.
METHODS
This was a single-center, retrospective case-control study. In total, 171 patients with CDI were included as cases and 342 age- and gender-matched patients without CDI were used as controls. We compared the prevalence of CKD in the study sample and identified independent risk factors that could predict the development or prognosis of CDI.
RESULTS
Independent risk factors for CDI included stage IV to V CKD not requiring dialysis (odds ratio [OR], 2.90) and end-stage renal disease requiring dialysis (OR, 3.34). Patients with more advanced CKD (estimated glomerular filtration rate < 30) and CDI showed higher in-hospital mortality and poorer responses to the initial metronidazole therapy.
CONCLUSIONS
More advanced CKD is an independent risk factor for CDI and is associated with higher in-hospital mortality and poor treatment responses in CDI patients. Thus, in CKD patients, careful attention should be paid to the occurrence of CDI and its management to improve the outcome of CDI.

Keyword

Renal insufficiency, chronic; Clostridium difficile; Dialysis; Risk factors

MeSH Terms

Aged
Anti-Infective Agents/therapeutic use
Chi-Square Distribution
Clostridium difficile/*pathogenicity
Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*microbiology/mortality
Female
Hospital Mortality
Humans
Kidney Failure, Chronic/*complications/diagnosis/therapy
Logistic Models
Male
Metronidazole/therapeutic use
Middle Aged
Multivariate Analysis
Odds Ratio
Prevalence
Renal Dialysis
Renal Insufficiency, Chronic/*complications/diagnosis/mortality/therapy
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Treatment Outcome
Anti-Infective Agents
Metronidazole