The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kim, Sun Chul (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Seo, Min Young (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Lee, Jun Yong (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Kim, Ki Tae (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Cho, Eunjung (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Kim, Myung-Gyu (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Jo, Sang-Kyung (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Cho, Won-Yong (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital) ;
  • Kim, Hyoung-Kyu (Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital)
  • Received : 2014.03.07
  • Accepted : 2014.09.03
  • Published : 2016.01.01
⟨ Previous Next ⟩

Abstract

Background/Aims: 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. Methods: 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. Results: 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. Conclusions: 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.

Keywords

References

  1. Howell MD, Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010;170:784-790. https://doi.org/10.1001/archinternmed.2010.89
  2. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40:1-15.
  3. Anand A, Glatt AE. Clostridium difficile infection associated with antineoplastic chemotherapy: a review. Clin Infect Dis 1993;17:109-113. https://doi.org/10.1093/clinids/17.1.109
  4. McFarland LV, Surawicz CM, Stamm WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678-684. https://doi.org/10.1093/infdis/162.3.678
  5. McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204-210. https://doi.org/10.1056/NEJM198901263200402
  6. Peniche AG, Savidge TC, Dann SM. Recent insights into Clostridium difficile pathogenesis. Curr Opin Infect Dis 2013;26:447-453.
  7. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442-2449. https://doi.org/10.1056/NEJMoa051639
  8. Pepin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005;173:1037-1042. https://doi.org/10.1503/cmaj.050978
  9. Kuijper EJ, van Dissel JT, Wilcox MH. Clostridium difficile: changing epidemiology and new treatment options. Curr Opin Infect Dis 2007;20:376-383.
  10. Eddi R, Malik MN, Shakov R, Baddoura WJ, Chandran C, Debari VA. Chronic kidney disease as a risk factor for Clostridium difficile infection. Nephrology (Carlton) 2010;15:471-475. https://doi.org/10.1111/j.1440-1797.2009.01274.x
  11. Pardi DS. Recurrent Clostridium difficile infection: an immunodeficiency state? Clin Gastroenterol Hepatol 2007;5:672-673. https://doi.org/10.1016/j.cgh.2007.03.025
  12. Aronsson B, Barany P, Nord CE, Nystrom B, Stenvinkel P. Clostridium difficile-associated diarrhoea in uremic patients. Eur J Clin Microbiol 1987;6:352-356. https://doi.org/10.1007/BF02017639
  13. McConnell JB, Stewart WK, Thjodleifsson B, Wormsley KG. Gastric function in chronic renal failure: effects of maintenance haemodialysis. Lancet 1975;2:1121-1123.
  14. Hida M, Aiba Y, Sawamura S, Suzuki N, Satoh T, Koga Y. Inhibition of the accumulation of uremic toxins in the blood and their precursors in the feces after oral administration of Lebenin, a lactic acid bacteria preparation, to uremic patients undergoing hemodialysis. Nephron 1996;74:349-355. https://doi.org/10.1159/000189334
  15. Keddis MT, Khanna S, Noheria A, Baddour LM, Pardi DS, Qian Q. Clostridium difficile infection in patients with chronic kidney disease. Mayo Clin Proc 2012;87:1046-1053. https://doi.org/10.1016/j.mayocp.2012.05.025
  16. Yousuf K, Saklayen MG, Markert RJ, Barde CJ, Gopalswamy N. Clostridium difficile-associated diarrhea and chronic renal insufficiency. South Med J 2002;95:681-683.
  17. Mullane KM, Cornely OA, Crook DW, et al. Renal impairment and clinical outcomes of Clostridium difficile in-fection in two randomized trials. Am J Nephrol 2013;38:1-11. https://doi.org/10.1159/000351757
  18. Anders HJ, Andersen K, Stecher B. The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease. Kidney Int 2013;83:1010-1016. https://doi.org/10.1038/ki.2012.440
  19. Betjes MG. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol 2013;9:255-265. https://doi.org/10.1038/nrneph.2013.44
  20. Monaghan T, Boswell T, Mahida YR. Recent advances in Clostridium difficile-associated disease. Gut 2008;57:850-860.
  21. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431-455. https://doi.org/10.1086/651706

Cited by

  1. Clostridium difficile Infection in Special High-Risk Populations vol.5, pp.3, 2016, https://doi.org/10.1007/s40121-016-0124-z
  2. Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort vol.44, pp.None, 2016, https://doi.org/10.1016/j.anaerobe.2017.03.003
  3. Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of He vol.97, pp.1, 2016, https://doi.org/10.1007/s00277-017-3183-7
  4. Metronidazole therapy as initial treatment of Clostridium difficile infection in patients with chronic kidney disease in Korea vol.147, pp.None, 2019, https://doi.org/10.1017/s0950268819001742
  5. Risk, Outcomes, and Trends of Clostridium Difficile Infection in Multiple Myeloma Patients from a Nationwide Analysis vol.11, pp.4, 2019, https://doi.org/10.7759/cureus.4391
  6. Hygienemaßnahmen bei Clostridioides difficile-Infektion (CDI) : Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut vol.62, pp.7, 2019, https://doi.org/10.1007/s00103-019-02959-1
  7. Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China vol.10, pp.None, 2016, https://doi.org/10.3389/fcimb.2020.578098
  8. Particular aspects of gastroenterological disorders in chronic kidney disease and end-stage renal disease patients: a clinically focused review vol.55, pp.2, 2020, https://doi.org/10.1080/00365521.2020.1722217
  9. Assessment of Kidney Injury as a Severity Criteria for Clostridioides Difficile Infection vol.7, pp.11, 2016, https://doi.org/10.1093/ofid/ofaa476
  10. Clostridioides difficile Infection in Chronic Kidney Disease—An Overview for Clinicians vol.10, pp.2, 2021, https://doi.org/10.3390/jcm10020196
  11. Nonalcoholic Fatty Liver Disease-A Novel Risk Factor for Recurrent Clostridioides difficile Infection vol.10, pp.7, 2021, https://doi.org/10.3390/antibiotics10070780