AMSTERDAM—Advanced chronic kidney disease (CKD) is a risk factor for infection with Clostridium difficile (CDI) according to study findings presented at the 51st Congress of the European Renal Association-European Dialysis and Transplant Association.

Kyung Kyu Kim, MD, and collaborators at Korea University Anam Hospital in Seoul, Korea, compared 171 patients CDI and 342 age- and sex-matched control patients without CDI. Stage IV-V CKD not requiring dialysis and end-stage renal disease requiring dialysis were associated with a nearly 2.9 and 4.9 times increased risk of CDI, respectively.

Among patients with CDI, more advanced CKD (estimated glomerular filtration rate below 30 mL/min/1.73 m2) was associated with higher in-hospital mortality (21.9% vs. 5.0%).

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Additionally, the use of 2 or more antibiotics, prior use of vancomycin, the presence of pseudomembranous colitis, elevated white blood cell coutn, high C-reactive protein levels, and advanced CKD stages were significantly associated with poor response to initial metronidazole treatment, according to the investigators.