Predicting recurrent Clostridioides difficile infection by assessing antimicrobial treatment based on days of antibiotic spectrum coverage and ATLAS scores

Abstract

Introduction

We aimed to determine the impact of prior antimicrobial treatment on recurrent Clostridioides difficile infection (CDI) based on days of antibiotic spectrum coverage (DASC) and predict the risk of recurrence to guide the selection of appropriate initial therapeutic agents.

Methods

We assessed the antimicrobial treatment administered to 195 patients with a history of CDI for 28 days before testing positive for C. difficile using DASC and illness severity using ATLAS scores. We determined DASC cutoff values and combined them with relevant factors in ATLAS to determine an association with CDI recurrence.

Results

Forty-four patients had recurrences of C. difficile infection. The median (interquartile range, IQR) DASC value was significantly higher in the group with recurrent CDI (78 [50–128]) than without (48 [12–99]; p = 0.01). Cutoff values of 36 and 66 for DASC were determined using receiver operating characteristic (ROC) curves. Age and serum creatinine were associated with CDI recurrence according to ATLAS scores. We assessed the risk of recurrence by combining age, serum creatinine, and DASC scores. A scoring system was created by assigning each variable a score from 0 to 2. The area under the ROC curve for this scoring system was 0.70.

Conclusion

Assessing antimicrobial treatment using DASC before CDI can predict recurrence and should facilitate the selection of initial therapy for CDI.