Incidence of and risk factors for recurrent Clostridioidesdifficile infection in Japan using a claims database: A retrospective cohort study

This retrospective cohort study aimed to determine the incidence rates of and risk factors for recurrent Clostridioides difficile infection (rCDI) in Japan using a claims database. Inpatients of any age with ≥1 record of C. difficile infection (CDI) during the study period (January 2012–September 2016) were analyzed. We estimated the incidence rate of health care onset, health care facility associated (HO-HCFA) primary CDI and HO-HCFA rCDI for each of the first to fifth recurrences. Risk factors for the first recurrence were investigated using a univariate, and subsequently, a multivariable Cox regression model. The incidence rates (95% confidence interval [CI]) of CDI and HO-HCFA CDI were 2.43 (2.40–2.46) and 1.26 (1.24–1.28) cases per 10,000 inpatient-days, respectively. Among the 11,287 inpatients with ≥1 HO-HCFA CDI, 1424 patients had ≥1 recurrent episode (12.6% [95% CI 12.0–13.2]). The rCDI incidence rates consistently increased, with the number of recurrences ranging from 29.2 to 181.8 cases per 10,000 inpatient-days. The multivariable analysis revealed five risk factors (hazard ratio [95% CI]): age ≥65 years (vs. <65 years; 65–74 years, 1.275 [1.048–1.551]; 75–79 years, 1.612 [1.315–1.975]; ≥80 years, 2.110 [1.776–2.507]); cephalosporin use both before (vs. without cephalosporin; 1.241 [1.098–1.402]) and during the primary CDI (vs. without cephalosporin; 1.137 [1.011–1.279]); higher number of comorbidities (vs. ≤10 comorbidities; 11–14 comorbidities: 1.336 [1.131–1.580]; 15–20 comorbidities: 1.433 [1.219–1.685]; ≥21 comorbidities: 1.310 [1.099–1.561]); and gastrointestinal surgery (vs. without surgery; 0.823 [0.701–0.965]). In conclusion, CDI recurred in some Japanese patients, and the incidence rates increased with the number of recurrences. Special care is needed in patients aged ≥65 years, those with a higher number (>10) of comorbidities, and those who have received cephalosporin before or during the primary CDI.