Beyond Pain Relief: Is Opioids Use Safe in Clostridium difficile Infection?

Clostridium difficile infection (CDI) is a common condition in hospitalized patients. In the USA, there has been an alarming rise in the use of opioids for analgesia during hospitalization. Due to their antiperistalsis effect, opioids can increase absorption of bacterial toxins. Our study aimed to highlight any correlation between opioids use in CDI and morbidity, mortality, and duration of hospitalization.

A retrospective study was performed, and data were collected from 321 hospitalized patients with CDI. The dosage of opioids received in the first 4 days following diagnosis was calculated. Patients were divided into two groups (control group vs. opioid group). Reassessment of severity of disease on day 4 was performed. Complications, hospital mortality, readmissions for CDI within 3 months, length of stay, and disposition at discharge were compared.

The opioid arm consisted of 169 patients, and 152 patients served as controls. On day 4, the number of patients with severe disease was significantly higher in the opioid group versus controls (78 (46.1%) vs. 37 (24%), respectively, P < 0.01), and complications including ileus, high white blood cell count, and need for vasopressors were significantly higher in the opioid group (27.8% versus 16.4%, P = 0.01). Control group patients were more likely to be discharged home (47% vs. 33%, P = 0.04), while opioid group required predominantly long-term facilities care after discharge.

Opioid usage for analgesia in CDI increases the risk for severe disease, complications, longer hospitalization, readmission rates, hospital mortality and discharge to a long-term facility.