Clinical and Microbiological Risk Factors for Clinical and Microbiological Risk Factors for Severe Clostridioides difficile Infections

Abstract

Background: There has been a marked increase in the mortality rate associated withClostridioides difficile infection (CDI) globally since 2003, with the emergence of binary toxinproducingribotype 027 strains. However, the molecular epidemiology of C. difficile showsregional differences and ribotype 027 is not common in Korea. In this study, the risk factorsfor severe CDI were evaluated, while considering the region-specific molecular epidemiology. Methods: A retrospective case-control study was performed. Cases (n = 149) included patientswith severe CDI or severe complicated CDI. Controls (n = 155) consisted of patients with nonsevereCDI. Results: Advanced age (odds ratio [OR] = 1.017, P = 0.0358), a history of chemotherapy (OR =2.695, P = 0.0464), and ribotype 002 (OR = 3.406, P = 0.0231) were statistically significant factorsassociated with severe CDI in a multivariate analysis. Conclusion: Ribotype 002 was found to be a significant risk factor for severe CDI in this study. Therefore, the surveillance of C. difficile ribotypes is recommended to monitor the spread ofhigh-risk clones.