{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:34:46Z","timestamp":1791952486363,"version":"4.3.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["2R01AI139261"],"award-info":[{"award-number":["2R01AI139261"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32 AI141349"],"award-info":[{"award-number":["T32 AI141349"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK124567"],"award-info":[{"award-number":["DK124567"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Fulminant Clostridioides difficile infection (FCDI) is associated with a 30%\u201340% mortality rate. Guideline definitions for FCDI severity classification include ileus, megacolon, shock, or hypotension. However, no hypotension definition is provided, making application of the definition challenging. The objective of this study was to assess optimal hypotension definitions for FCDI severity criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a multicenter cohort study involving 1172 hospitalized patients diagnosed with C difficile infection (CDI) from 2015 to 2022 (Houston cohort). Patients were assessed for a composite endpoint of colectomy or mortality within 30 days of diagnosis. The ability of the CDI severity criteria to predict the composite endpoint was assessed using 2 definitions of hypotension (systolic blood pressure [SBP] \u226490\u2005mm Hg and mean arterial pressure [MAP] \u226465\u2005mm Hg) through multivariable regression models. A separate CDI cohort of 494 hospitalized patients validated the results (Midwest cohort).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The composite endpoint was similar in the Houston cohort (98 patients [8.4%]) and the Midwest cohort (26 patients [5.3%]). Using either a MAP \u226465\u2005mm Hg or SPB \u226490\u2005mm Hg as criteria for hypotension was the best-performing model in both the development and validation cohorts. Removal of hypotension was the worst-performing model in both cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Inclusion of hypotension, defined as SBP \u226490\u2005mm Hg or MAP \u226465\u2005mm Hg, was an important component of FCDI severity criteria, significantly improving the predictive ability to identify FCDI patients at risk for poor outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf033","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T15:41:05Z","timestamp":1737560465000},"source":"Crossref","is-referenced-by-count":4,"title":["Defining Fulminant <i>Clostridioides difficile<\/i> Infections: Assessing the Utility of Hypotension as a Diagnostic Criterion"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0999-7340","authenticated-orcid":false,"given":"Hubert C","family":"Chua","sequence":"first","affiliation":[{"name":"Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy, Long Island University , Brooklyn, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taryn A","family":"Eubank","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4861-7646","authenticated-orcid":false,"given":"Allen","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9213-7850","authenticated-orcid":false,"given":"Krishna","family":"Rao","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhee","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2063-7503","authenticated-orcid":false,"given":"Kevin W","family":"Garey","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne J","family":"Gonzales-Luna","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"2025022510035579300_ofaf033-B1","doi-asserted-by":"crossref","DOI":"10.15620\/cdc:82532","volume-title":"Antibiotic resistance threats in the United States, 2019","author":"Centers for Disease Control and Prevention (CDC)","year":"2019"},{"key":"2025022510035579300_ofaf033-B2","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1080\/13696998.2020.1724117","article-title":"Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data 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