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Aim <p>The definition of severe <i>Clostridioides difficile</i> infection (CDI) in the European (ESCMID) guidelines differs from that in the American (IDSA/SHEA, ACG) guidelines. This study aims to compare the two classification schemes using our cohort of patients with severe-complicated CDI (scCDI) accumulated over the last 11 years.</p> Methods <p>A retrospective study analyzing patients with scCDI hospitalized from 2014 to 2024. The frequency and significance of the individual scCDI criteria were evaluated and discussed. Additionally, Fisher’s exact test was applied.</p> Results <p>A total of 1,913 patients were hospitalized with CDI. Among these, 24 patients (1.25%) met the criteria for scCDI, with a median age of 77.5 years (range: 59–91 years). The mortality rate in this group was 71%. Toxic megacolon developed in 15 patients, sepsis without colonic dilatation was observed in 7 patients, and 2 patients experienced colonic dilatation without signs of sepsis. Notably, no patient presented with fever upon admission. Leukocytosis was found in 18 patients (75%), and elevated serum creatinine levels were noted in 16 patients (67%). Additional supporting factors (colonic distension, pericolonic fat stranding, or colonic wall thickening) were diagnosed in all but one patient. Hypotension and/or shock were recorded in 18 cases (75%), and colonic dilatation occurred in 17 patients (71%). Bowel perforation was reported in 2 patients with toxic megacolon. Fisher’s exact test showed no statistically significant associations between diagnostic criteria, surgical interventions, and patient outcomes.</p> Conclusions <p>The ESCMID definition of severe and severe-complicated CDI could be enhanced. Certain criteria, such as fever and bowel perforation, appear unnecessary. We recommend increasing the cut-off value for leukocytosis. Furthermore, the additional supporting factors recommended by ESCMID should be integrated into the standard criteria of severe CDI.</p>

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Severe-Complicated Clostridioides difficile Infection: Comments to the Current ESCMID Guidelines

  • 期刊论文

  • 发表日期：

    2025年9月15日

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  • Katarína Halmová,
  • Olga Džupová,
  • Marek Ďuríček,
  • Hynek Bartoš,
  • Martin Kucbel,
  • Jiří Beneš

摘要

Aim

The definition of severe Clostridioides difficile infection (CDI) in the European (ESCMID) guidelines differs from that in the American (IDSA/SHEA, ACG) guidelines. This study aims to compare the two classification schemes using our cohort of patients with severe-complicated CDI (scCDI) accumulated over the last 11 years.

Methods

A retrospective study analyzing patients with scCDI hospitalized from 2014 to 2024. The frequency and significance of the individual scCDI criteria were evaluated and discussed. Additionally, Fisher’s exact test was applied.

Results

A total of 1,913 patients were hospitalized with CDI. Among these, 24 patients (1.25%) met the criteria for scCDI, with a median age of 77.5 years (range: 59–91 years). The mortality rate in this group was 71%. Toxic megacolon developed in 15 patients, sepsis without colonic dilatation was observed in 7 patients, and 2 patients experienced colonic dilatation without signs of sepsis. Notably, no patient presented with fever upon admission. Leukocytosis was found in 18 patients (75%), and elevated serum creatinine levels were noted in 16 patients (67%). Additional supporting factors (colonic distension, pericolonic fat stranding, or colonic wall thickening) were diagnosed in all but one patient. Hypotension and/or shock were recorded in 18 cases (75%), and colonic dilatation occurred in 17 patients (71%). Bowel perforation was reported in 2 patients with toxic megacolon. Fisher’s exact test showed no statistically significant associations between diagnostic criteria, surgical interventions, and patient outcomes.

Conclusions

The ESCMID definition of severe and severe-complicated CDI could be enhanced. Certain criteria, such as fever and bowel perforation, appear unnecessary. We recommend increasing the cut-off value for leukocytosis. Furthermore, the additional supporting factors recommended by ESCMID should be integrated into the standard criteria of severe CDI.