We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome.

Centre for Infectious Diseases Research Diagnostics and Laboratory Surveillance Rijksinstituut voor Volksgezondheid en Milieu 2333 Bilthoven The Netherlands

Centre International de Recherche en Infectiologie Université de Lyon 69372 Lyon France

Clinical Microbiology and Public Health Laboratory Public Health England Addenbrooke's Hospital Hills Road Cambridge CB2 0QQ UK

Critical Care Department Vall d'Hebron Hospital Vall d'Hebron Institut de Recerca SODIR Group Universitat Autònoma de Barcelona 08035 Barcelona Spain

Department of Gastroenterology and Hepatology Jagiellonian University Medical College 30 688 Krakow Poland

Department of Hematology Jagiellonian University Medical College 30 688 Krakow Poland

Department of Infectious and Tropical Diseases Jagiellonian University Medical College 30 688 Krakow Poland

Department of Internal and Geriatric Diseases Jagiellonian University Medical College 30 688 Krakow Poland

Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia University of Catania 95123 Catania Italy

Department of Medical Microbiology Centre for Infectious Diseases Leiden University Medical Center 2333 Leiden The Netherlands

Department of Medical Microbiology Charles University 2nd Faculty of Medicine and Motol University Hospital 15006 Prague Czech Republic

Department of Medical Microbiology Medical University of Warsaw 02 004 Warsaw Poland

Department of Metabolic Diseases Jagiellonian University Medical College 30 688 Krakow Poland

Department of Nephrology and Dialysis Unit Jagiellonian University Medical College 30 688 Krakow Poland

Department of Pain Treatment and Palliative Care Jagiellonian University Medical College 30 688 Krakow Poland

Department of Propaedeutics of Medicine and Infection Prevention Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University 85 094 Bydgoszcz Poland

ESCMID Study Group for Clostridioides Difficile 4001 Basel Switzerland

Hygienic Department Bács Kiskun County Teaching Hospital 6000 Bács Kiskun Hungary

Institut Micalis UMR 1319 Université Paris Saclay INRAe AgroParisTech 92290 Châtenay Malabry France

Intensive Care Unit University Hospital 30 688 Krakow Poland

Józef Babiński Hospital 30 393 Krakow Poland

Ludwik Rydygier Hospital 31 826 Krakow Poland

Service de Microbiologie Clinique Groupe Hospitalier Paris Saint Joseph 75014 Paris France

Unité d'Hygiène Epidémiologie et Prévention Groupement Hospitalier Centre Hospices Civils de Lyon 69002 Lyon France

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