Factors Affecting Treatment and Recurrence of <i>Clostridium difficile</i> Infections

Abstract

The antimicrobial agents vancomycin and metronidazole have been used to treat Clostridium difficile infections (CDIs). However, it remains unclear why patients are at risk of treatment failure and recurrence. Therefore, this study retrospectively examined 98 patients with CDIs who were diagnosed based on the detection of toxin-positive C. difficile to determine the risk factors affecting drug treatment responses and the recurrence of CDI. No significant difference was observed in the cure rate or dosage between the vancomycin and metronidazole groups. The 90-d mortality rate and total number of drugs associated with CDIs, including antiinfective agents used within 2 months before the detection of toxin-positive C. difficile, were significantly lower in the treatment success group than in the failure group. The total number of antiinfective agents and gastric acid-suppressive agents used during CDI therapy was also significantly lower in the success group than in the failure group. The period from the completion of CDI therapy to restarting the administration of anticancer agents and steroids was significantly longer in patients without than in patients with recurrence. These results indicate that the total number of drugs associated with CDIs should be minimized to reduce the risk of CDIs, that not only antibiotics but also gastric acid-suppressive agents should be discontinued during CDI therapy to increase therapeutic efficacy, and that the use of anticancer agents and steroids should be delayed as long as possible after patients are cured by CDI therapy to prevent recurrence.

Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

“…There are no estimates of CDI-attributable mortality in Japan that are directly comparable to our study. Other studies have reported an all-cause, 30-day mortality rate of 3.4-15.1% in patients with CDI [13,[25][26][27][28][29][30]. In our study, the all-cause hospital mortality in the CDI hospitalisation rate was 22.1%, which was higher than previously reported from Japan but similar to the hospital mortality in the US study of patients with sepsis (24.0%).…”

The Epidemiology of Clostridium difficile Infection in Japan: A Systematic Review

“…Known risk factors for CDI include: co- and previously administered broad-spectrum antibiotics; age and comorbidities; poor infection-control practices; GI tract surgery; and gastric-acid suppressing agents [ 13 , 34 – 36 ]. Thirteen studies in our search, including a large database study representing 40% of all adult-care hospitalizations, identified risk factors for CDI in Japanese patients, which included older age, higher comorbidity index; gastric acid-suppressing proton pump inhibitors (PPIs); and a longer pre-operative LOS before GI surgery [ 19 , 20 , 24 – 26 , 29 , 31 , 32 , 36 – 40 ] (Table 1 ).…”

Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset

“…In Japan, risk factors identified previously for initial and/or recurrent CDI included malignant disease, use of PPIs, and ICU hospitalization [12,18]. Matsumoto et al found that, in addition to antibiotics, initiation of treatment with acid-suppressive agents, anticancer drugs or steroids shortly after completing CDI therapy was also associated with a greater risk of CDI recurrence [26]. In our study, ICU admission was not associated with rCDI risk, but chemotherapy was marginally associated with rCDI risk, as was PPI use after adjusting for exposure period.…”