TY - JOUR
T1 - Prognostic factors for severe and recurrent Clostridioides difficile infection
T2 - a systematic review
AU - van Rossen, Tessel M.
AU - Ooijevaar, Rogier E.
AU - Vandenbroucke-Grauls, Christina M. J. E.
AU - Dekkers, Olaf M.
AU - Kuijper, Ed J.
AU - Keller, Josbert J.
AU - van Prehn, Joffrey
N1 - Funding Information:
TvR was supported by the Netherlands Organization for Health Research and Development (ZonMw) grant Goed Gebruik Geneesmiddelen, project number 848016009. JK and EK received a research grant from Vedanta Biosciences (Boston, USA). The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. All other authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021
Y1 - 2021
N2 - Objectives: Clostridioides difficile infection (CDI), its subsequent recurrences (rCDIs), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices. In this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI. Methods: PubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. The study eligibility criteria were cohort and case–control studies. Participants were patients ≥18 years old diagnosed with CDI, in which clinical or laboratory factors were analysed to predict sCDI/rCDI. Risk of bias was assessed by using the Quality in Prognostic Research (QUIPS) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool modified for prognostic studies. Study selection was performed by two independent reviewers. Overview tables of prognostic factors were constructed to assess the number of studies and the respective effect direction and statistical significance of an association. Results: 136 studies were included for final analysis. Greater age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were greater age, healthcare-associated CDI, prior hospitalization, proton pump inhibitors (PPIs) started during or after CDI diagnosis, and previous rCDI. Conclusions: Prognostic factors for sCDI and rCDI could aid clinicians to make treatment decisions based on risk stratification. We suggest that future studies use standardized definitions for sCDI/rCDI and systematically collect and report the risk factors assessed in this review, to allow for meaningful meta-analysis of risk factors using data of high-quality trials.
AB - Objectives: Clostridioides difficile infection (CDI), its subsequent recurrences (rCDIs), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices. In this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI. Methods: PubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. The study eligibility criteria were cohort and case–control studies. Participants were patients ≥18 years old diagnosed with CDI, in which clinical or laboratory factors were analysed to predict sCDI/rCDI. Risk of bias was assessed by using the Quality in Prognostic Research (QUIPS) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool modified for prognostic studies. Study selection was performed by two independent reviewers. Overview tables of prognostic factors were constructed to assess the number of studies and the respective effect direction and statistical significance of an association. Results: 136 studies were included for final analysis. Greater age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were greater age, healthcare-associated CDI, prior hospitalization, proton pump inhibitors (PPIs) started during or after CDI diagnosis, and previous rCDI. Conclusions: Prognostic factors for sCDI and rCDI could aid clinicians to make treatment decisions based on risk stratification. We suggest that future studies use standardized definitions for sCDI/rCDI and systematically collect and report the risk factors assessed in this review, to allow for meaningful meta-analysis of risk factors using data of high-quality trials.
KW - Clostridioides difficile
KW - Clostridium difficile
KW - Prediction
KW - Prognostic factors
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85119214427&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2021.09.026
DO - 10.1016/j.cmi.2021.09.026
M3 - Review article
C2 - 34655745
JO - Clinical Microbiological and Infection
JF - Clinical Microbiological and Infection
SN - 1469-0691
ER -