1. External Validation of Three Prediction Tools for Patients at Risk of a Complicated Course of Clostridium difficile Infection: Disappointing in an Outbreak Setting
- Author
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Yvette H. van Beurden, Olaf M. Dekkers, Saskia le Cessie, M.P.M. Hensgens, Christina M. J. E. Vandenbroucke-Grauls, Chris J. J. Mulder, Gastroenterology and hepatology, Medical Microbiology and Infection Prevention, AII - Infectious diseases, and AGEM - Digestive immunity
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,Pediatrics ,genetic structures ,Epidemiology ,medicine.medical_treatment ,030501 epidemiology ,Risk Assessment ,Decision Support Techniques ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Colectomy ,Aged ,Cross Infection ,business.industry ,Clostridioides difficile ,Area under the curve ,External validation ,Outbreak ,Reproducibility of Results ,Clostridium difficile ,Middle Aged ,Icu admission ,Infectious Diseases ,Cohort ,Clostridium Infections ,0305 other medical science ,business ,Validation cohort - Abstract
OBJECTIVEEstimating the risk of a complicated course of Clostridium difficile infection (CDI) might help doctors guide treatment. We aimed to validate 3 published prediction models: Hensgens (2014), Na (2015), and Welfare (2011).METHODSThe validation cohort comprised 148 patients diagnosed with CDI between May 2013 and March 2014. During this period, 70 endemic cases of CDI occurred as well as 78 cases of CDI related to an outbreak of C. difficile ribotype 027. Model calibration and discrimination were assessed for the 3 prediction rules.RESULTSA complicated course (ie, death, colectomy, or ICU admission due to CDI) was observed in 31 patients (21%), and 23 patients (16%) died within 30 days of CDI diagnosis. The performance of all 3 prediction models was poor when applied to the total validation cohort with an estimated area under the curve (AUC) of 0.68 for the Hensgens model, 0.54 for the Na model, and 0.61 for the Welfare model. For those patients diagnosed with CDI due to non-outbreak strains, the prediction model developed by Hensgens performed the best, with an AUC of 0.78.CONCLUSIONAll 3 prediction models performed poorly when using our total cohort, which included CDI cases from an outbreak as well as endemic cases. The prediction model of Hensgens performed relatively well for patients diagnosed with CDI due to non-outbreak strains, and this model may be useful in endemic settings.Infect Control Hosp Epidemiol 2017;38:897–905
- Published
- 2017
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