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

• Published in: The Korean journal of internal medicine 2016, 31(1), , pp.125-133
• Main Authors: Kim, Sun Chul, Seo, Min Young, Lee, Jun Yong, Kim, Ki Tae, Cho, Eunjung, Kim, Myung-Gyu, Jo, Sang-Kyung, Cho, Won-Yong, Kim, Hyoung-Kyu
• Format: Article
• Language: English
• Subjects: Aged; Anti-Infective Agents - therapeutic use; Chi-Square Distribution; Clostridium difficile - pathogenicity; Enterocolitis, Pseudomembranous - diagnosis; Enterocolitis, Pseudomembranous - drug therapy; Enterocolitis, Pseudomembranous - microbiology; Enterocolitis, Pseudomembranous - mortality; Female; Hospital Mortality; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - therapy; Logistic Models; Male; Metronidazole - therapeutic use; Middle Aged; Multivariate Analysis; Odds Ratio; Original; Prevalence; Renal Dialysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - therapy; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Treatment Outcome; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2016.31.1.125

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. 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. 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. 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.