Treatment of Clostridium difficile infection in a French university hospital

The management of Clostridium difficile infection (CDI) has become very daunting over the past decade because of increased incidence and severity both in hospital and the community. Guidelines recommend metronidazole, vancomycin, or fidaxomicin, depending on clinical presentation.

Our objective was to describe CDI management and assess empirical CDI therapy complying with practice guidelines.

We performed a 2-year prospective cohort study in a university teaching hospital in Lyon, France. Criteria assessing the conformity of CDI patient management were: time elapsed between testing and start of treatment specific to CDI, antibiotics to fight CDI and treatment duration according to infection severity, concomitant therapy, and use of antidiarrheal drugs.

Among 118 patients with confirmed CDI, 98 (83%) were specifically treated for CDI. Severe CDI was observed in 63 patients (53.9%). Treatment included metronidazole alone in 72 patients (73.5%), vancomycin alone in 1 patient (1%), and both in 25 patients (25.5%). The percentage of CDI treatment compliance with published guidelines in our hospital at the study period varied between 22% and 93%. A total of 16 patients (13.6%) died within 30 days after diagnosis. Death was related to CDI in nine patients (56.3% of deceased cases).

This study identified significant gaps in our knowledge of CDI treatment. Increasing disease severity highlights the need to investigate antibiotic treatment in severely ill CDI patients, as data on this group are currently lacking.