Epidemiology, risk factors and outcomes of Clostridioides difficile infection in a UK district general hospital: a retrospective cohort study.
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BACKGROUND: Clostridioides difficile infection (CDI) remains a major healthcare-associated infection, causing substantial morbidity and mortality. Relapse and recurrence continue to pose significant management challenges. AIM: The aim of this study was to evaluate risk factors, ribotype distribution and treatment outcomes, relapse, recurrence and 30-day mortality, among CDI patients in a UK district general hospital. METHODS: A retrospective cohort study included all adult and paediatric inpatient and outpatient cases diagnosed with CDI between April 2023 and August 2024. Demographic characteristics, risk factors, CDI onset type, treatment regimens, ribotypes, relapse, recurrence and 30-day all-cause mortality were extracted from electronic records and analysed descriptively. RESULTS: In total, 124 CDI episodes were analysed: 45.2% hospital-onset healthcare-associated, 16.1% community-onset healthcare-associated, 33.0% community-onset community-associated and 5.6% community-onset indeterminate. First episodes accounted for 84.7%, with relapse in 12.9% and recurrence in 2.4%. Key risk factors included prolonged or multiple hospitalisations (74%), broad-spectrum antibiotic exposure (71%), proton pump inhibitor therapy (49%), gastrointestinal disease (31.4%) and malignancy (24%). Patients aged >75 years had the highest relapse/recurrence rate (63.2%). Relapse (9%) and recurrence (4%) occurred among those treated with oral vancomycin, whereas no relapse or recurrence was observed among patients who received fidaxomicin monotherapy. Ribotyping was completed in 108 cases (87.1%). Four ribotypes, CE002, CE005, CE015 and CE020, were most frequent (each N = 11); CE001 accounted for seven cases, and 12.9% were untyped. The 30-day all-cause mortality rate was 7.3% (N = 9), predominantly in older patients with comorbidities and hospital-acquired infection. CONCLUSIONS: Relapse and recurrence were more frequently observed among older patients and those with repeated hospitalisation, prior broad-spectrum antibiotic exposure, and gastrointestinal or malignant disease. No further episodes were observed among patients who received fidaxomicin monotherapy in this cohort. Ribotype patterns revealed predominance of non-hypervirulent strains, supporting strengthened stewardship and routine ribotype-informed surveillance.