Clostridioides difficile infections: Epidemiology, correlations and treatment in a Lebanese cohort with use of ATLAS scoring

Abstract

Introduction: The objectives of the present study were to investigate epidemiology, correlations, severity, and therapeutic response of Clostridioides difficile infections in a Lebanese tertiary care hospital.
 Methodology: In this retrospective cohort study, patients having at least one positive Clostridioides difficile test (antigen glutamate dehydrogenase/GDH with toxins, or PCR) were studied.
 Results: Among 58 patients, 20 (34.5%) and 53 (91.4%) had positive antigen GDH and toxins, respectively. PCR was performed in 25 (43.1%) patients without any positive ribotype 027. Fifteen (25.9%) patients were immunocompromised, 35 (60.3%) patients received antibiotics prior to the infection and 34 (58.6%) on proton pump inhibitors. Fifty-four (93%) patients had a resolution of their symptoms after a mean period of 4.2 days of treatment. Twenty-two (38%) participants were treated with oral vancomycin, 11 (19%) with intravenous metronidazole and 23 (39.6%) with both antibiotics. Resolution of symptoms was significantly more rapid with monotherapy (p = 0.007) with no significant difference between vancomycin and metronidazole (p = 0.413). A positive correlation was found between ATLAS score and delay to symptoms resolution (r = 0.553; p < 0.001; N = 54), as well as between ATLAS score and prevalence of complications (p = 0.003).
 Conclusions: History of treatment with antibiotics, proton pump inhibitors, and hospital admission during the previous year were prevalent among our patient cohort. Rates of symptomatic resolution were similar with monotherapy and dual therapy.

Characteristics, Risk Factors, and Prevalence of Clostridioides difficile Among Hospitalized Patients in a Tertiary Care Hospital in Palestine

“…This finding is similar to recent regional studies conducted in Lebanon and Saudi Arabia to assess the risk factors for CDI revealed that the majority of participants diagnosed with CDI received antibiotics prior to the infection. 20 , 21 A recent study in Egypt reported that patients with antibiotic treatment are at higher risk for CDI. 22 The pathophysiology of antimicrobial agents disrupts the normal gastrointestinal flora, resulting in decreased body defenses against C. difficile , making it easier for C. difficile to produce toxins that cause CDI disease.…”

The Laboratory Diagnosis of Clostridioides difficile Infection: An update of current laboratory practice

“…Several studies have described risk factors for CDI, which include previous antibiotics, proton pump inhibitors, elderly age, and previous hospitalization. The use of the ATLAS scoring system facilitates risk stratification, prediction, and management of recurrent CDI [75].…”