Kuntz et al reported a model for predicting the risk of Clostridium difficile after an outpatient healthcare visit. The authors are from Kaiser Permanente, University of Colorado, McGill University and the University of Washington.
Patient selection: age from 20 to 89
Outcome: Clostridium difficile disease
Parameters:
(1) age in years
(2) sex
(3) days of hospitalization in the previous 60 days
(4) history of stay in communal-living healthcare facility
(5) chronic kidney disease
(6) inflammatory bowel disease
(7) immunosuppression
(8) chronic lung disease
(9) rheumatologic disease
(10) diabetes
(11) cardiovascular disease
(12) liver disease
(13) malignancy
(14) chemotherapy
(15) beta lactam antibiotic with or without beta-lactamase inhibitor
(16) cephalosporin
(17) clindamycin
(18) fluorquinolone
(19) macrolides
(20) sulfonamides
(21) tetracyclines
(22) gastric acid suppression
|
Parameter |
Finding |
Points |
|
age in years |
20 to 24 |
2 |
|
|
25 to 29 |
3 |
|
|
30 t 34 |
5 |
|
|
35 to 39 |
8 |
|
|
40 to 44 |
12 |
|
|
45 to 49 |
18 |
|
|
50 to 54 |
28 |
|
|
55 to 59 |
38 |
|
|
60 to 64 |
49 |
|
|
65 to 69 |
59 |
|
|
70 to 74 |
69 |
|
|
75 to 79 |
79 |
|
|
80 to 84 |
90 |
|
85 to 89 |
100 |
|
|
sex |
male |
0 |
|
|
female |
6 |
|
days of hospitalization |
0 |
0 |
|
|
1 to 6 |
8 |
|
|
>= 7 |
37 |
|
stay in communal-living |
no |
0 |
|
|
yes |
24 |
|
chronic kidney disease |
no |
0 |
|
|
yes without dialysis |
32 |
|
|
yes with dialysis |
25 |
|
inflammatory bowel disease |
no |
0 |
|
|
yes |
43 |
|
immunosuppression |
no |
0 |
|
|
yes |
22 |
|
chronic lung disease |
no |
0 |
|
|
yes |
6 |
|
rheumatologic disease |
no |
0 |
|
|
yes |
5 |
|
diabetes |
no |
0 |
|
|
yes |
13 |
|
cardiovascular disease |
no |
0 |
|
|
yes |
19 |
|
liver disease |
no |
0 |
|
|
yes |
47 |
|
malignancy |
no |
0 |
|
|
yes |
22 |
|
chemotherapy |
no |
0 |
|
|
yes |
12 |
|
beta lactam antibiotic |
no |
0 |
|
|
yes |
27 |
|
cephalosporin |
no |
0 |
|
|
yes |
38 |
|
clindamycin |
no |
0 |
|
|
yes |
58 |
|
fluoroquinolone |
no |
0 |
|
|
yes |
25 |
|
macrolides |
no |
0 |
|
|
yes |
21 |
|
suflonamides |
no |
0 |
|
|
yes |
6 |
|
tetracyclines |
no |
3 |
|
|
yes |
0 |
|
gastric acid suppressants |
no |
0 |
|
|
yes |
12 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 2
• maximum score: 578
• The higher the score the greater the risk of Clostridium difficile.
|
Total Score |
Percent Risk |
|
<= 128 |
< 1% |
|
129 to 157 |
1-2% |
|
158 to 174 |
2-3% |
|
175 to 186 |
3-4% |
|
187 to 196 |
4-5% |
|
197 to 203 |
5-6% |
|
204 to 210 |
6-7% |
|
211 to 216 |
7-8% |
|
217 to 221 |
8-9% |
|
222 to 225 |
9-10% |
|
>= 226 |
>= 10% |
Performance:
• The area udner the ROC curve is 0.79.
Specialty: Infectious Diseases
