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Belmares J, Gerding DN, Parada JP, Miskevics S, Weaver F, Johnson S. Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system. J Infect 2007; 55(6): 495-501. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31(5): 431-55. Fujitani S, George WL, Murthy AR. Comparison of clinical severity score indices for Clostridium difficile infection. Infect Control Hosp Epidemiol 2011; 32(3): 220-8. Gujja D, Friedenberg FK. Predictors of serious complications due to Clostridium difficile infection. Aliment Pharmacol Ther 2009; 29(6): 635-42. Jardin CGM, Palmer HR, Shah DN, et al. Assessment of treatment patterns and patient outcomes before vs after implementation of a severity-based Clostridium difficile infection treatment policy. Journal of Hospital Infection 2013; 85(1): 28-32. Lungulescu OA, Cao W, Gatskevich E, Tlhabano L, Stratidis JG. CSI: a severity index for Clostridium difficile infection at the time of admission. J Hosp Infect 2011; 79(2): 151-4. McEllistrem MC, Carman RJ, Gerding DN, Genheimer CW, Zheng L. A hospital outbreak of Clostridium difficile disease associated with isolates carrying binary toxin genes. Clin Infect Dis 2005; 40(2): 265-72. Na X, Martin AJ, Sethi S, et al. A Multi-Center Prospective Derivation and Validation of a Clinical Prediction Tool for Severe Clostridium difficile Infection. PLoS One 2015; 10(4): e0123405. Rao K, Micic D, Natarajan M, et al. Clostridium difficile Ribotype 027: Relationship to Age, Detectability of Toxins A or B in Stool with Rapid Testing, Severe Infection, and Mortality. Clin Infect Dis 2015; 61(2): 233-41. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007; 45(3): 302-7. This work was supported by grants from the Claude D. Pepper Older Americans Independence Center [grant number AG024824], the Michigan Institute for Clinical and Health Research [grant number 2UL1TR000433], and the National Institutes of Health, National Institute of Allergy and Infectious Diseases [grant numbers U19-AI090871, R21AI120599, & U01AI124255]. Contact: Krishna Rao krirao@med.umich.edu

Performance of Published Clostridium difficile Severity Scoring Systems in an External Cohort