Clinical and Microbiological Risk Factors for Severe Clostridioides difficile Infections

Background: There has been a marked increase in the mortality rate associated with Clostridioides difficile infection (CDI) globally since 2003, with the emergence of binary toxinproducing ribotype 027 strains. However, the molecular epidemiology of C. difficile shows regional differences and ribotype 027 is not common in Korea. In this study, the risk factors for severe CDI were evaluated, while considering the region-specific molecular epidemiology. Methods: A retrospective case-control study was performed. Cases (n = 149) included patients with severe CDI or severe complicated CDI. Controls (n = 155) consisted of patients with nonsevere CDI. Results: Advanced age (odds ratio [OR] = 1.017, P = 0.0358), a history of chemotherapy (OR = 2.695, P = 0.0464), and ribotype 002 (OR = 3.406, P = 0.0231) were statistically significant factors associated with severe CDI in a multivariate analysis. Conclusion: Ribotype 002 was found to be a significant risk factor for severe CDI in this study. Therefore, the surveillance of C. difficile ribotypes is recommended to monitor the spread of high-risk clones.