Epidemiology and Recurrence Rates of Clostridium difficile Infections in Germany: A Secondary Data Analysis

Abstract

Introduction Clostridium difficile infection (CDI) is the most common cause of health-care-associated infectious diarrhea. Recurrence rates are as high as 20–30% after standard treatment with metronidazole or vancomycin, and appear to be reduced for patients treated with fidaxomicin. According to the literature, the risk of CDI recurrence increases after the second relapse to 30–65%. Accurate data for Germany are not yet available.MethodsBased on the research database of arvato health analytics (Munich, Germany), a secondary data analysis for the incidence, treatment characteristics and course of CDI was performed. The database included high granular accounting information of about 1.46 million medically insured patients covering the period 2006–2013, being representative for Germany. The analysis was based on new-onset CDI in 2012 in patients which either received outpatient antibiotic therapy for CDI or were hospitalized.ResultsThe ICD-10 coded incidence of CDI in 2012 was 83 cases per 100,000 population. Overall mortality rates within the follow-up period of 1 year were 13.5% in inpatients with primary diagnosis of CDI, compared to 24.3% in inpatients with secondary diagnosis of CDI (P < 0.001), and 7.1% in outpatients (P < 0.001). In the median, patients with secondary diagnosis of CDI remained significantly longer hospitalized (24 vs. 9 days, P < 0.001). First recurrence of CDI was observed in 18.2% of cases with index events. There was a significantly increased risk to suffer a second and third recurrence, reaching 28.4% (P < 0.001), and 30.2% (P = 0.017), respectively. Antibiotic therapy of CDI in outpatients was performed mainly with metronidazole (in 90.8% of index events, 60.0% of first recurrences, and 43.5% of second recurrences).ConclusionThe reported incidence of CDI in Germany is higher than noted previously. The recurrence rates do increase with the number of relapses, but are lower than reported in the literature, despite dominance of metronidazole treatment in outpatients.FundingMSD Sharp & Dohme GmbH, Haar, Germany.

Derivation and Validation of aClostridium difficileInfection Recurrence Prediction Rule in a National Cohort of Veterans

“…Patients with community-onset, nonsevere CDI might be discharged on outpatient therapy more quickly than those who develop CDI in the hospital or who have other comorbid conditions that necessitate inpatient treatment. 28 CDI treatment regimens typically include antibiotics taken 3–4 times daily, which could limit patient adherence in the outpatient setting, thus reducing the likelihood of C. difficile eradication. Furthermore, strict precautions are taken to prevent the spread of spores in a patient’s hospital environment compared to home, which could play a role in the association between duration of hospitalization and CDI recurrence.…”

Gastrointestinal Microbiome – What We Need to Know in Clinical Practice

“…Presently, the standard treatment for an initial nonsevere CDI episode is oral vancomycin or fidaxomicin [91]. Around a quarter of all patients with CDI will have a recurrence, with increasing rates in each subsequent episode [92]. An investigation by Seekatz et al [93] elucidated that intestine microbiota in recurrent CDI patients and severe CDI trended towards a lower diversity community, but differences between these two groups were less pronounced when comparing CDI with healthy patients.…”

Antibiotika und der Gastrointestinaltrakt – Update 2019

“…C.-difficile-assoziierter Diarrhö (CDAD) steigen weltweit nicht nur im Krankenhaus, sondern auch bei am-bulanten Patienten an [29]. Für Deutschland wird eine Inzidenz von mindestens 80 Fällen pro 100 000 Einwohner und Jahr angenommen [30].…”

“…Trotz klinisch erfolgreicher primärer Therapie kommt es bei ca. 20-30 % der CDI-Patienten in Deutschland zu mindestens einem Rezidiv der Erkrankung [30]. In einem Teil der Fälle handelt es sich möglicherweise um Neuinfektionen.…”