Clostridium difficile Infection in Hospitalized Cirrhotic Patients with Hepatic Encephalopathy

Stoica, Oana; Stanciu, C; Cojocariu, Camelia; Miftode, Egidia; Boiculese, Lucian; Trifan, Anca; Gîrleanu, Irina

doi:10.15403/jgld.2014.1121.244.csd

Cited by 10 publications

(4 citation statements)

References 40 publications

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“…In our cohort, the incidence of CDI cirrhotic patients was 24.8 cases per 10,000 person-year, lower than the incidence reported in a cohort of cirrhotic patients with HE [ 18 ]. Previous studies demonstrated that in the general population treated with antibiotics, 5% of the patients developed CDI [ 19 ]; in our cohort 6.7% developed CDI during norfloxacin secondary SBP prophylaxis.…”

Section: Discussioncontrasting

confidence: 75%

The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort

et al. 2021

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Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Antibiotic prophylaxis is effective but can lead to an increased incidence of Clostridioides difficile infection (CDI). The aim of this study was to evaluate the incidence of CDI and the risk factors in cirrhotic patients with a previous episode of SBP receiving norfloxacin as secondary prophylaxis. Materials and Methods: We performed a prospective, cohort study including patients with liver cirrhosis and SBP, successfully treated over a 2-year period in a tertiary university hospital. All the patients received secondary prophylaxis for SBP with norfloxacin 400 mg/day. Results: There were 122 patients with liver cirrhosis and SBP included (mean age 57.5 ± 10.8 years, 65.5% males). Alcoholic cirrhosis was the major etiology accounting for 63.1% of cases. The mean MELD score was 19.7 ± 6.1. Twenty-three (18.8%) of all patients developed CDI during follow-up, corresponding to an incidence of 24.8 cases per 10,000 person-years. The multivariate Cox regression analysis demonstrated that alcoholic LC etiology (HR 1.40, 95% CI 1.104–2.441, p = 0.029) and Child-Pugh C class (HR 2.50, 95% CI 1.257–3.850, p = 0.034) were independent risk factors for CDI development during norfloxacin secondary prophylaxis. The development of CDI did not influence the mortality rates in cirrhotic patients with SBP receiving norfloxacin. Conclusions: Cirrhotic patients with SBP and Child-Pugh C class and alcoholic liver cirrhosis had a higher risk of developing Clostridioides difficile infection during norfloxacin secondary prophylaxis. In patients with alcoholic Child-Pugh C class liver cirrhosis, alternative prophylaxis should be evaluated as SBP secondary prophylaxis.

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Section: Discussioncontrasting

confidence: 75%

The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort

et al. 2021

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“…First, HE was found to be associated with a decreased risk of CDI despite being associated with an increased risk of bacterial infections. This is rarely commented on in the literature, with another study coming to the opposite conclusion . The effect of medications commonly used to treat HE offers potential explanations.…”

Section: Discussionmentioning

confidence: 96%

The rise of Clostridioides difficile infections and fall of associated mortality in hospitalized advanced cirrhotics

Rosenblatt

Mehta

Cohen‐Mekelburg

et al. 2019

Liver International

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Background & Aims: Cirrhotics are at increased risk of Clostridioides difficile infection (CDI) and its associated high morbidity and mortality. However, the impact of CDI in cirrhotics over time remains unclear. This study analyses prevalence and mortality in CDI in hospitalized patients with advanced cirrhosis over 15 years and identifies trends. Methods: Using the Nationwide Inpatient Sample (NIS) from 1998 to 2014, 3 049 696 weighted patients with advanced cirrhosis (defined as evidence of decompensation or oesophageal varices) were identified using a validated algorithm of ICD-9-CM codes and included in the study. Trends were analysed using Cochran Armitage test and joinpoint regression and compared to the general population. Multivariable logistic regression was performed controlling for risk factors that affect mortality in cirrhotics.

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“…Some local data also provide epidemiological figures for CDI in cirrhosis. In a study from a tertiary hospital in Romania [ 35 ], CDI occurred in 7.3% of 231 patients with cirrhosis coexisting with hepatic encephalopathy (HE) (mainly stage 2 or 3) between 2012 and 2014, with an overall CDI incidence of 57.2 cases per 10,000 patient days. In a small prospective study conducted in Romania in 2015, among 200 Child-Pugh B and C patients hospitalized for decompensation, 9% developed CDI during their hospitalization [ 36 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…Age >65 years, multiple hospitalizations, inpatient stays >20 days, hypoproteinemia, Clostridioides difficile colonization (CDC), HE, antibiotic, and proton pump inhibitors (PPIs) use were found to be associated with the development of CDI in a study conducted to identify risk factors for CDI in patients with cirrhosis [ 45 ]. Furthermore, many studies have also reported risk factors for CDI development [ 22 , 23 , 30 , 32 , 35 , 37 , 39 , 46 – 49 ] although heterogeneity exists between studies. The risk factors concluded from these studies are largely in line with the previous research and can be broadly classified into several categories, namely medications (PPIs, antibiotics, etc.…”

Section: Risk Factorsmentioning

confidence: 99%

Clostridioides difficile Infection in Liver Cirrhosis: A Concise Review

Liu

Chen

2022

Canadian Journal of Gastroenterology and Hepatology

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Clostridium difficile is a Gram-positive bacillus with fecal-oral transmission and is currently one of the most common nosocomial infections worldwide, which was renamed Clostridioides difficile in 2016. Clostridioides difficile infection (CDI) is a prevalent infection in cirrhosis and negatively affects prognosis. This study aimed to provide a concise review with clinical practice implications. The prevalence of CDI in cirrhotic patients increases, while the associated mortality decreases. Multiple groups of risk factors increase the likelihood of CDI in patients with cirrhosis, such as antibiotic use, the severity of cirrhosis, some comorbidities, and demographic aspects. Treatment in the general population is currently described in the latest guidelines. In patients with cirrhosis, rifaximin and lactulose have been shown to reduce CDI risk due to their modulatory effects on the intestinal flora, although conflicting results exist. Fecal microbiota transplantation (FMT) as a treatment for the second or subsequent CDI recurrences has demonstrated a good safety and efficacy in cirrhosis and CDI. Future validation in more prospective studies is needed. Screening of asymptomatic patients appears to be discouraged for the prevention currently, with strict hand hygiene and cleaning of the ward and medical equipment surfaces being the cornerstone of minimizing transmission.

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Clostridium difficile Infection in Hospitalized Cirrhotic Patients with Hepatic Encephalopathy

Abstract: Hospitalized cirrhotics with HE are at risk for developing CDI, and clinicians treating such patients should be aware of this infection as rapid detection and prompt treatment may improve outcomes.

Cited by 10 publications

References 40 publications

The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort

The Risk of Clostridioides difficile Infection in Cirrhotic Patients Receiving Norfloxacin for Secondary Prophylaxis of Spontaneous Bacterial Peritonitis—A Real Life Cohort

The rise of Clostridioides difficile infections and fall of associated mortality in hospitalized advanced cirrhotics

Clostridioides difficile Infection in Liver Cirrhosis: A Concise Review

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