Meta-analysis to assess risk factors for recurrent Clostridium difficile infection

Garey, Kevin W.; Sethi, Saurabh; Yadav, Yashoo; DuPont, Herbert L.

doi:10.1016/j.jhin.2008.08.012

Cited by 354 publications

(275 citation statements)

References 24 publications

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“…17,26,42 These patient factors should be incorporated in clinical decision making, perhaps influencing the choice of initial antibiotic therapy for CDI and also suggesting that these patients be monitored closely for complications from CDI. In addition, these confounding variables should be controlled for in any subsequent studies that assess the association between acid suppression and CDI incidence or outcomes.…”

Section: Discussionmentioning

confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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Objective: To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium difficile infection (CDI) in a population-based cohort. Patients and Methods: To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents. Results: Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; PϽ.001) and more likely to have severe (34.2% vs 23.6%; Pϭ.03) or severecomplicated (4.4% vs 2.6% CDI; Pϭ.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severecomplicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found. Conclusion: In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.

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Section: Discussionmentioning

confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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“…Thus far, widespread evidence has revealed that various factors predictive of rCDI-similar to those already mentioned for CDI-are suspected of microbiome modulation, including PPIs, antibiotic re-exposure after CDI treatment, fluoroquinolone use, appendectomy, surgery, chemotherapy, low immunoglobulin levels against C. difficile toxin A or B, age, and infection with hypervirulent B1/NAP1/ribotype 027 strains [45][46][47][48][49][50][51]. Other risk factors include the presence of an ileal pouch [52], fecal incontinence, and concomitant antacid use and hypoalbuminemia [47,[53][54][55]. For pediatric cases, recent evidence from Nicholson and colleagues showed that among 186 pediatric patients, malignancy (OR 3.39, 95 % CI 1.52-7.85), recent surgery (OR 2.40; 95 % CI 1.05-5.52), and the number of antibiotic exposures by class (OR 1.33, 95 % CI 1.01-1.75) were significantly associated with recurrent CDI [56].…”

Section: Recurrent C Difficile Infection (Rcdi)mentioning

confidence: 92%

Recurrent Clostridium difficile infection and the microbiome

2015

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The diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. As our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (FMT) and microbial ecosystem therapeutics (MET) for a variety of diseases. The potential role of FMT and MET in the treatment of Clostridium difficile infection (CDI)-currently the leading nosocomial gastrointestinal infection-has proven highly effective for recurrent CDI, and has emerged as a paradigm shift in the treatment of this disease. The current review will serve as a summary of the key aspects of CDI, and will introduce the essential framework and challenges of FMT, as is currently practiced. MET represents the progression of conventional bacteriotherapy that fundamentally capitalizes on the restorative properties of intestinal bacterial communities and may be viewed as the culmination of a rationally designed therapeutic modality. As our understanding of the composition and function of the intestinal microbiota evolves, it will likely drive next-generation microbiota therapies for a range of medical conditions, such as inflammatory bowel disease, obesity, and metabolic syndrome.

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“…In a prospective study of 209 patients with recurrent CDI, logistic regression revealed only two signifi cant independent risk factors for CDI recurrence: increased age and a lower quality of health at enrollment ( 238 ). One meta-analysis of 12 studies totaling 1,382 patients with recurrent CDI and found risk factors for recurrent CDI that included continued use of non-C. diffi cile antibiotics (odds ratio (OR) = 4.23, 95 % CI 2.1 -8.5), antacids (OR = 2.1, 95 % CI 1.1 -4.1), and older age (OR = 1.6, 95 % CI 1.1 -2.4) ( 239 ). Another group developed a prediction rule with a 77 % accuracy based on three risk factors: age >65 years, severe or fulminant illness, and additional antibiotic use aft er CDI therapy was completed ( 240 ).…”

Section: Conflict Of Interestmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,477

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Meta-analysis to assess risk factors for recurrent Clostridium difficile infection

Cited by 354 publications

References 24 publications

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Recurrent Clostridium difficile infection and the microbiome

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

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