TOPLINE:

In hospitalised patients with Clostridioides difficile infection, older age, intermediate care or ICU admission, liver disease with ascites, colonisation with vancomycin‑resistant Enterococcus, parenteral nutrition, and receipt of sodium bicarbonate therapy were associated with poor outcomes.

METHODOLOGY:

• Researchers in Germany conducted a retrospective cohort study to identify determinants of adverse outcomes, recurrence, and prolonged hospitalisations among 87 patients with C difficile infection (mean age, 60.7 years; 64.4% men) hospitalised from 2012 to 2014.
• At infection onset, patients were classified on the basis of the level of care — general ward or intermediate care unit/ICU — and acquisition route — hospital onset if symptoms began more than 48 hours after admission and community onset otherwise.
• Clinical factors assessed included antibiotics, sodium bicarbonate therapy, nutritional factors, and colonisation with vancomycin-resistant Enterococcus; disease severity was defined by standard laboratory and clinical criteria.
• The primary endpoint was a composite of major adverse clinical events consisting of surgery, in-hospital death, or severe life-threatening manifestations caused by C difficile infection.
• Secondary outcomes included infection recurrence, length of hospital stay, and antibiotic exposures.

TAKEAWAY:

• Overall, major adverse clinical events occurred in 16.1% of patients; admission to the intermediate care unit/ICU was strongly associated with these events (P = .0169). Factors associated with higher mortality were admission to the intermediate care unit/ICU, older age, and the receipt of sodium bicarbonate therapy.
• Recurrence occurred in 21.8% of patients. Colonisation with vancomycin-resistant Enterococcus (P = .048) and sodium bicarbonate therapy (P = .033) conferred a higher risk for recurrence. Within the intermediate care unit/ICU cohort, colonisation with vancomycin-resistant Enterococcus was associated with a nearly 16-fold higher risk for recurrence (P = .015).
• Parenteral nutrition, liver cirrhosis, and the presence of ascites were linked to a longer hospital stay. Parenteral nutrition was also associated with an increased risk for more severe disease.
• Exposure to cephalosporins and piperacillin/tazobactam was associated with an increased risk for severe disease, and exposure to carbapenems and piperacillin/tazobactam was associated with hospital-onset acquisition.

IN PRACTICE:

"[The study] findings emphasize the multifactorial nature of CDI [C difficile infection] severity, shaped by host vulnerability, microbial ecology, and therapeutic exposures," the authors wrote.

SOURCE:

This study was led by Mohamad Amer Nashtar, Ruhr University, Bochum, Germany. It was published online on February 05, 2026, in The Journal of Hospital Infection.

LIMITATIONS:

This study was limited by its retrospective, single-centre design and the relatively small sample size. Key outcomes such as 30-day mortality and recurrence after discharge were not consistently captured. Residual confounding could have influenced the findings. In addition, data were collected from 2012 to 2014, and management standards have evolved since then.

DISCLOSURES:

The authors did not declare any funding sources or competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.