Prognostic factors for severe and recurrent Clostridioides difficile infection: a systematic review

Tessel M. van Rossen; Rogier E. Ooijevaar; Christina M. J. E. Vandenbroucke-Grauls; Olaf M. Dekkers; Ed J. Kuijper; Josbert J. Keller; Joffrey van Prehn

doi:10.1016/j.cmi.2021.09.026

Prognostic factors for severe and recurrent Clostridioides difficile infection: a systematic review

Tessel M. van Rossen^*
, Rogier E. Ooijevaar^*
, Christina M. J. E. Vandenbroucke-Grauls
, Olaf M. Dekkers
, Ed J. Kuijper
, Josbert J. Keller
, Joffrey van Prehn

^*Corresponding author for this work

Aarhus University
Leiden University
Department of Gastroenterology and Hepatology, Haaglanden Medical Center, Postbus 432, 2501 CK The Hague, The Netherlands

Research output: Contribution to journal › Review article › Academic › peer-review

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Abstract

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.

Original language	English
Journal	Clinical microbiology and infection
Early online date	2021
DOIs	https://doi.org/10.1016/j.cmi.2021.09.026
Publication status	E-pub ahead of print - 2021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Clostridioides difficile
Clostridium difficile
Prediction
Prognostic factors
Systematic review

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Cite this

@article{154c28e94f064734bcfb9cd30dd81de6,

title = "Prognostic factors for severe and recurrent Clostridioides difficile infection: a systematic review",

abstract = "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.",

keywords = "Clostridioides difficile, Clostridium difficile, Prediction, Prognostic factors, Systematic review",

author = "\{van Rossen\}, \{Tessel M.\} and Ooijevaar, \{Rogier E.\} and Vandenbroucke-Grauls, \{Christina M. J. E.\} and Dekkers, \{Olaf M.\} and Kuijper, \{Ed J.\} and Keller, \{Josbert J.\} and \{van Prehn\}, Joffrey",

note = "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: {\textcopyright} 2021 The Author(s)",

year = "2021",

doi = "10.1016/j.cmi.2021.09.026",

language = "English",

journal = "Clinical microbiology and infection",

issn = "1198-743X",

publisher = "Elsevier Limited",

}

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 - https://www.scopus.com/pages/publications/85119214427

U2 - 10.1016/j.cmi.2021.09.026

DO - 10.1016/j.cmi.2021.09.026

M3 - Review article

C2 - 34655745

SN - 1198-743X

JO - Clinical microbiology and infection

JF - Clinical microbiology and infection

ER -

Prognostic factors for severe and recurrent Clostridioides difficile infection: a systematic review

Abstract

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Keywords

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