Four Point Test Flags Patients at Risk of Dying from Clostridium difficile Infection

Analysis of metabolic and mortality data from a group of patients with Clostridium difficile infections has allowed the establishment of a prediction rule based on clinical variables to aid hospital physicians to rank incoming patients according to risk of dying from the infection.

C. difficile is an anaerobic, spore forming, rod shaped bacterium, and is a prevalent cause of nosocomial infection. Furthermore, antibiotic resistant strains of C. difficile are a growing problem in healthcare systems. Recent C. difficile epidemics have been caused by hypervirulent strains, which became resistant to the fluoroquinolones soon after their introduction into the healthcare setting.


When C. difficile bacteria are introduced into a colon in which the normal gut flora has been destroyed (usually after a broad-spectrum antibiotic such as clindamycin has been used), the gut becomes overrun with C. difficile. This overpopulation is harmful because the bacteria release toxins that can cause bloating and diarrhea, with abdominal pain, which may become severe. C. difficile infections are the most common cause of pseudomembranous colitis, and in rare cases, this can progress to toxic megacolon, which can be life threatening.

Investigators at the University of Exeter (United Kingdom) and the Royal Devon & Exeter Hospital (United Kingdom) evaluated over 186 variables collated retrospectively from clinical data for 213 patients. From this data, they devised a simple four variable prediction rule that included serum albumin levels, respiratory rate, C-reactive protein, and white cell count. Threshold levels of these variables were associated with an increased risk of all-cause mortality.

Contributing author Dr. Steve Michell, senior lecturer in molecular microbiology at the University of Exeter, said, "Our findings are exciting because they identify a simple, accurate, and robust method to identify those patients who are at risk of dying from a C difficile infection. The clinical variables identified are easily measurable, using tests that are commonly carried out in hospital. The results of our study strengthen the evidence for establishing the use of this rule in clinical settings: the benefits to patient well-being, the efficient management of infection in hospital and potential savings to the NHS and other health services around the world, would be immense."

The study was published in the July 12, 2013, online edition of the journal BMC Infectious Diseases.

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University of Exeter
Royal Devon & Exeter Hospital