OBJECTIVE: A frequent complication of Clostridium difficile infection (CDI) is 
recurrent disease. The aim of this study was to determine whether early 
recurrence risk was higher after infection with ribotype 027 (outbreak strain) 
compared with infection with endemic strain types of C. difficile.
METHODS: Consecutive patients diagnosed with CDI between May 2013 and March 2014 
were included (outbreak strain, and non-outbreak strains). Patients who 
developed recurrent CDI within 30 days after completion of CDI treatment, were 
compared with patients without a recurrence. Medical charts were reviewed for 
demographic and clinical characteristics. General practitioners were contacted 
to complete data about the occurrence of recurrent CDI, and the use of 
medication after hospital discharge.
RESULTS: In total, 135 patients were at risk for the development of recurrent 
CDI; 74 patients were infected by ribotype 027, and 61 patients by other 
ribotypes. Thirty-nine patients (29%) developed recurrent CDI within 30 days 
after completion of CDI treatment. In multivariable analysis, age ≥70 years (HR 
3.05, 95% CI 1.54-6.03), and a duration of CDI treatment ≥11 days (HR 1.92, 95% 
CI 1.00-3.69) were clearly associated with recurrence; infection with ribotype 
027 showed a HR of 1.72 (95% CI 0.88-3.33).
CONCLUSION: During this outbreak of C. difficile in a tertiary care centre, age 
and a prolonged duration of CDI therapy (which is most likely a marker of 
underlying disease severity) were the main risk factors for recurrent CDI. This 
points to host factors as more important predictors for recurrent CDI than 
strain type or antibiotic use.