Background & Aims: Clostridium di cile is recognized as the major cause of nosocomial gastroenteritis usually related to antibiotic treatment. Although treatable, C. di cile–associated disease (CDAD) tends to recur in many patients. e purpose of the study was to analyze the risk factors for recurrence in patients with CDAD after the rst treatment with vancomycin, metronidazole or both. Method: We conducted a retrospective study of all patients admitted to the Teaching Hospital of Infectious Diseases Cluj-Napoca, Romania, between January 2011 and October 2012 with the diagnosis of CDAD or who developed diarrhoea after admission. A clinical diagnosis was made and culture and toxin A and B detection were carried out. We performed a statistical analysis taking into consideration: age, gender, previous hospital exposure, previous antibiotic treatment, and treatment duration. e patients were followed-up for at least 60 days.

Results: We included 306 patients (177 women and 129 men) with a median age of 71 years; 208 patients (68%) had prior hospitalization and 195 (64%) had received prior antibiotic treatment. Actual treatment consisted of vancomycin in 76 (25%) patients, metronidazole in 132 (43%) and both combined in 98 (32%) patients. e average duration of treatment was 10 days. Sixty patients (20%) experienced 95 recurrences and 9 patients died (3%). Treatment with metronidazole, vancomycin or both for 10 or more days did not prevent recurrences. Age over 70 (RR 1.5, CI 95%: 1.055-2.71) and use of PPI (RR 1.3, CI 95%: 1.16-3.1) signi cantly increased the risk of rst recurrence of CDAD.

Conclusions: CDAD recurrence rates were similar to those reported in the literature. e risk of rst recurrence was signi cantly higher in patients older than 70 who also received PPI treatment.