Validation of clinical risk tools for recurrent Clostridioides difficile infection.

OBJECTIVE: We sought to validate available tools for predicting recurrent C. difficile infection (CDI) including recurrence risk scores (by Larrainzar-Coghen, Reveles, D'Agostino, Cobo, and Eyre et al ) alongside consensus guidelines risk criteria, the leading severity score (ATLAS), and PCR cycle threshold (as marker of fecal organism burden) using electronic medical records.

DESIGN: Retrospective cohort study validating previously described tools.

SETTING: Tertiary care academic hospital.

PATIENTS: Hospitalized adult patients with CDI at University of Virginia Medical Center.

METHODS: Risk scores were calculated within ±48 hours of index CDI diagnosis using a large retrospective cohort of 1,519 inpatient infections spanning 7 years and compared using area under the receiver operating characteristic curve (AUROC) and the DeLong test. Recurrent CDI events (defined as a repeat positive test or symptom relapse within 60 days requiring retreatment) were confirmed by clinician chart review.

RESULTS: Reveles et al tool achieved the highest AUROC of 0.523 (and 0.537 among a subcohort of 1,230 patients with their first occurrence of CDI), which was not substantially better than other tools including the current IDSA/SHEA C. difficile guidelines or PCR cycle threshold (AUROC: 0.564), regardless of prior infection history.

CONCLUSIONS: All tools performed poorly for predicting recurrent C. difficile infection (AUROC range: 0.488-0.564), especially among patients with a prior history of infection (AUROC range: 0.436-0.591). Future studies may benefit from considering novel biomarkers and/or higher-dimensional models that could augment or replace existing tools that underperform.