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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Increasing Incidence of Multiply Recurrent Clostridium difficile Infection in the United States: A Cohort Study
Gene K Ma1, Colleen M Brensinger1, Qufei Wu1
1From University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Background:
Clostridium difficile infection (CDI), the most common health care-associated infection, often recurs. Fecal microbiota transplantation is increasingly used to treat multiply recurrent CDI (mrCDI).
Objective:
To determine whether the incidence of mrCDI is increasing in proportion to CDI and to identify risk factors for mrCDI.
Design:
Retrospective cohort study.
Setting:
United States.
Participants:
38 911 718 commercially insured patients in the OptumInsight Clinformatics Database, of whom 45 341 developed CDI.
Measurements:
Age- and sex-standardized incidence rates for CDI and mrCDI.
Results:
From 2001 to 2012, the annual incidence of CDI and mrCDI per 1000 person-years increased by 42.7% (from 0.4408 to 0.6289 case) and 188.8% (from 0.0107 to 0.0309 case), respectively. The increase in mrCDI incidence was independent of known risk factors for CDI. Those who developed mrCDI were older (median age, 56.0 vs. 49.0 years; adjusted odds ratio [aOR] per 10-year increase in age, 1.25 [95% CI, 1.21 to 1.29]) and were more likely to be female (63.8% vs. 58.7%; aOR, 1.24 [CI, 1.11 to 1.38]) and to have used antibiotics (72.3% vs. 58.8%; aOR, 1.79 [CI, 1.59 to 2.01]), proton-pump inhibitors (24.6% vs. 18.2%; aOR, 1.14 [CI, 1.01 to 1.29]), or corticosteroids (18.3% vs. 13.7%; aOR, 1.15 [CI, 1.00 to 1.32]) within 90 days of CDI diagnosis. Chronic kidney disease (10.4% vs. 5.6%; aOR, 1.49 [CI, 1.24 to 1.80]) and diagnosis in a nursing home (2.1% vs. 0.6%; aOR, 1.99 [CI, 1.34 to 2.93]) were also associated with increased risk for mrCDI.
Limitation:
The primary analyses included only commercially insured patients in the United States.
Conclusion:
Relative to CDI, mrCDI incidence has disproportionately increased, indicating a rising demand for mrCDI therapies.
Primary Funding Source:
National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Allergy and Infectious Diseases.
Insights
The incidence of multiply recurrent Clostridium difficile infection (mrCDI) has increased significantly faster than overall CDI cases. This trend suggests a growing need for effective mrCDI treatments like fecal microbiota transplantation.
Area of Science:
- Infectious Diseases
- Epidemiology
- Gastroenterology
Background:
- Clostridium difficile infection (CDI) is a common healthcare-associated infection with frequent recurrence.
- Fecal microbiota transplantation (FMT) is an emerging treatment for multiply recurrent CDI (mrCDI).
Purpose of the Study:
- To assess the changing incidence of mrCDI relative to overall CDI.
- To identify risk factors associated with the development of mrCDI.
Main Methods:
- Retrospective cohort study utilizing a large US commercial insurance database (OptumInsight Clinformatics).
- Analysis of 38,911,718 patients, identifying 45,341 with CDI.
- Calculation of age- and sex-standardized incidence rates for CDI and mrCDI from 2001 to 2012.
Main Results:
- The incidence of mrCDI increased by 188.8%, significantly outpacing the 42.7% rise in overall CDI incidence.
- Older age, female sex, and prior use of antibiotics, proton-pump inhibitors, or corticosteroids were associated with higher mrCDI risk.
- Chronic kidney disease and nursing home residency were also linked to increased mrCDI risk.
Conclusions:
- The disproportionate increase in mrCDI incidence highlights a growing clinical need for advanced therapies.
- Findings indicate a rising demand for treatments such as fecal microbiota transplantation for mrCDI.
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