Response failure to the treatment of Clostridium difficile infection and its impact on 30-day mortality

Background/Aims: Few data are available on response failure and hospital mortality. This study aimed to evaluate the association between response failure to the treatment of CDI and 30-day mortality. Methods: Medical records of patients diagnosed with CDI between March 2005 and March 2010 were reviewed. CDI diagnosis was considered in patients with diarrhea when the stool toxins assay was positive or pseudomembranous colitis (PMC) was confirmed by endoscopy. If there were no symptomatic improvements during 10 days of treatment, the case was regarded as response failure. Patients were stratified into a mild or severe disease group based on clinical criteria. Results: Among 536 subjects (age 64±14.12, mild 266, severe 270), 26 (4.9%) showed response failure, which occurred more frequently in the severe disease than mild disease group. Forty eight (9%) died within 1 month and mortality rate in failure group was higher than response group (42.3% vs. 7.3%, p<0.001). Malignancy, albumin <2.5 mg/dL, WBC >15,000 cells/mm³, ICU admission, and response failure were independent risk factors associated with 30-day mortality after CDI. Conclusions: Response failure to the treatment negatively affects a patients' survival within 30 days after CDI.