Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort
Abstract Background Recurrent Clostridioides difficile infection is most effectively treated with faecal microbiota transplantation. Swedish and European guidelines suggest faecal microbiota transplantation after a first or second recurrence, respectively. The aims of this study were to evaluate ris...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12879-025-11495-0 |
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| author | Måns Stefansson Oscar Bladh Piotr Nowak Lars Rombo Magnus Hedenstierna Johan Ursing |
| author_facet | Måns Stefansson Oscar Bladh Piotr Nowak Lars Rombo Magnus Hedenstierna Johan Ursing |
| author_sort | Måns Stefansson |
| collection | DOAJ |
| description | Abstract Background Recurrent Clostridioides difficile infection is most effectively treated with faecal microbiota transplantation. Swedish and European guidelines suggest faecal microbiota transplantation after a first or second recurrence, respectively. The aims of this study were to evaluate risk factors for further relapses at the first and second recurrence, related to treatment recommendations. Methods Patients aged ≥ 18 years with two positive tests for C. difficile within eight weeks and treated at the study hospitals during 2014–2022 were eligible for inclusion. Retrospectively collected data included age, sex, treatment, and clinical characteristics for each episode. Risk factors for further recurrences at the first and second recurrence were identified using multivariable logistic regression analysis. Results The median age in the total cohort (n = 231) was 76 (IQR 67–84) years, 52% were females and 15% were healthy without comorbidities. One recurrence only occurred in 110 patients (48%), however, no clinically significant risk factors predicting more than one recurrence were identified. Two or more recurrences occurred in 110 patients, of whom, 44 (40%) had further recurrences. Frailty (Clinical Frailty Scale ≥ 4) was significantly associated with more than two recurrences (p = 0.03). The respective median times between the first and the second recurrences were 12 and 17 days in patients with more than two recurrences compared to two recurrences only (p = 0.02). Conclusions Patients experiencing a second recurrence of C. difficile infection who were frail and relapsed in a shorter time span after the first recurrence had a significantly increased risk of further recurrences. |
| format | Article |
| id | doaj-art-ce377d26e12c4e3cb324060ae04c0eae |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-ce377d26e12c4e3cb324060ae04c0eae2025-08-24T11:10:18ZengBMCBMC Infectious Diseases1471-23342025-08-0125111010.1186/s12879-025-11495-0Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohortMåns Stefansson0Oscar Bladh1Piotr Nowak2Lars Rombo3Magnus Hedenstierna4Johan Ursing5Department of Clinical Sciences Danderyd Hospital, Karolinska InstitutetDepartment of Clinical Sciences Danderyd Hospital, Karolinska InstitutetDepartment of Infectious Diseases, Karolinska University HospitalCentre for Clinical Research Sörmland, Uppsala UniversityDepartment of Infectious Diseases, Danderyd HospitalDepartment of Clinical Sciences Danderyd Hospital, Karolinska InstitutetAbstract Background Recurrent Clostridioides difficile infection is most effectively treated with faecal microbiota transplantation. Swedish and European guidelines suggest faecal microbiota transplantation after a first or second recurrence, respectively. The aims of this study were to evaluate risk factors for further relapses at the first and second recurrence, related to treatment recommendations. Methods Patients aged ≥ 18 years with two positive tests for C. difficile within eight weeks and treated at the study hospitals during 2014–2022 were eligible for inclusion. Retrospectively collected data included age, sex, treatment, and clinical characteristics for each episode. Risk factors for further recurrences at the first and second recurrence were identified using multivariable logistic regression analysis. Results The median age in the total cohort (n = 231) was 76 (IQR 67–84) years, 52% were females and 15% were healthy without comorbidities. One recurrence only occurred in 110 patients (48%), however, no clinically significant risk factors predicting more than one recurrence were identified. Two or more recurrences occurred in 110 patients, of whom, 44 (40%) had further recurrences. Frailty (Clinical Frailty Scale ≥ 4) was significantly associated with more than two recurrences (p = 0.03). The respective median times between the first and the second recurrences were 12 and 17 days in patients with more than two recurrences compared to two recurrences only (p = 0.02). Conclusions Patients experiencing a second recurrence of C. difficile infection who were frail and relapsed in a shorter time span after the first recurrence had a significantly increased risk of further recurrences.https://doi.org/10.1186/s12879-025-11495-0Clostridioides difficileRecurrent Clostridioides difficile infection |
| spellingShingle | Måns Stefansson Oscar Bladh Piotr Nowak Lars Rombo Magnus Hedenstierna Johan Ursing Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort BMC Infectious Diseases Clostridioides difficile Recurrent Clostridioides difficile infection |
| title | Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort |
| title_full | Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort |
| title_fullStr | Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort |
| title_full_unstemmed | Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort |
| title_short | Risk factors for further recurrences of Clostridioides difficile infection at the first and second recurrence: a retrospective cohort |
| title_sort | risk factors for further recurrences of clostridioides difficile infection at the first and second recurrence a retrospective cohort |
| topic | Clostridioides difficile Recurrent Clostridioides difficile infection |
| url | https://doi.org/10.1186/s12879-025-11495-0 |
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