Predictors of fatal outcomes in Clostridium difficile-associated infection

The steady increase in the incidence of the disease worldwide, the increase in the number of registered cases in the Russian Federation, the increase in the elderly and senile population, the possibility of over-the-counter and uncontrolled use of antibacterial drugs, the decreased alertness of physicians of various specialties regarding clostridial infection, the wide spectrum of clinical manifestations from asymptomatic carriage to severe course with life-threatening complications in the form of sepsis, septic shock, toxic megacolon, perforation, in most cases leading to death, places this disease among the most significant infectious diseases of our time.

Study Objective. To conduct a comparative analysis of anamnestic and clinical laboratory parameters in two groups of patients with Clostridium difficile-associated enterocolitis, depending on the disease outcome.

Materials and Methods. This was an observational, retrospective, case-control study. The medical records of 230 patients with Clostridium difficile infection were reviewed at the S.P. Botkin Clinical Infectious Diseases Hospital of St. Petersburg. The study was conducted from January to December 2025. Two groups were formed based on the disease outcome: patients with a favorable outcome (discharge from hospital) (n=188) and patients with a fatal outcome (n=42). A comparative analysis of age, hospital history, hospital stays, comorbidities, primary clinical manifestations, complications, clostridial toxins isolated in stool using ELISA, and other factors were conducted among the study subjects.

Conclusion. Older and advanced age, transfer from other healthcare facilities, the presence of concomitant cardiovascular and renal pathologies, and the simultaneous detection of two C. difficile toxins, A and B, in stool samples are the main predictors of fatal outcomes in Clostridium difficile infections.

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