Recurrence is a common sequela of Clostridium difficile -associated diarrhea (CDD) and may increase morbidity, costs, and treatment-related antimicrobial resistance. Because recurrent CDD (RCDD) frequently occurs very soon after an initial episode, our goal was to determine the risk factors for early RCDD (occurring £45 days after the initial episode). We conducted a case-control study, comparing 13 patients with early RCDD (case patients) with 46 patients who had only one CDD episode (control

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... atients) at Centre Hospitalier Angrignon (Québec) during January 1993 through November 1994. Risk factors for early RCDD included a history of chronic renal insufficiency, a white blood cell count of §15 1 10 3 /mm 3 , and community-acquired diarrhea with the first CDD episode. For seven of eight case patients, C. difficile strains from the first and second CDD episodes were identical, suggesting that relapse is more common than reinfection. These results suggest that treatments should be directed at preventing relapses in patients at high risk for early RCDD. Clinical Infectious Diseases 1998;26:954-9 Data abstracted from the medical records included demo-᭧ 1998 by The University of Chicago. All rights reserved. 1058-4838/98/2604-0024$03.00 graphics, chief complaint on presentation to the hospital, medi-/ 9c4a$$ap62 03-09-98 18:23:05 cidal UC: CID Downloaded from https://academic.oup.com/cid/article-abstract/26/4/954/415550 by guest on 27 July 2018 CID 1998;26 (April) Early recurrent C. difficile-Associated Diarrhea / 9c4a$$ap62 03-09-98 18:23:05 cidal UC: CID / 9c4a$$ap62 03-09-98 18:23:05 cidal UC: CID