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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and
Abdelkader Chaar1,2, John Damianos1, Rabia Rizwan1,2
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Background:
Clostridioides difficile infection (CDI) is an epidemic with the strongest risk factor being antibiotic usage. Patients who get CDI frequently require concomitant antibiotics for other indications around the time of their infection.
Aims:
To assess the recurrence of CDI (rCDI) in patients receiving concomitant antibiotics at the same time or shortly thereafter treatment of CDI.
Methods:
We retrospectively reviewed records for patients with their first inpatient CDI episode. Patients were grouped into those who didn't receive concomitant antibiotics (noABx), those receiving antibiotics at the same time as treatment of CDI (ABxDURING), those receiving antibiotics within 30-days of completion of CDI therapy (ABxAFTER) and those who received antibiotics both during and after CDI treatment (ABxDuringAfter). Our primary outcome was recurrence within 14-90 days; other outcomes included ICU stay at the time of diagnosis, 30-day ICU transfer, 30-day colectomy, and readmission.
Results:
457 patients had CDI during admission (mean age: 66.4 years, 51.9% female). 64.1% were exposed to concomitant antibiotics. Recurrence rates were 4.3%, 6.1%, 13.8% and 19.1%, for noABx, ABxDURING, ABxAFTER and ABxDuringAfter, respectively. Patients with ABxDuringAfter had the highest rates of rCDI when compared to noABx [OR 5.67, 95% CI (2.18-14.72)].
Conclusions:
There is a high rate of utilization of non-CDI antibiotics during or shortly after completing CDI treatment with high rates of recurrence within 90-days. Concomitant antimicrobials alter the opportunity for the microbiota to re-grow and worsens dysbiosis leading to increases in recurrence. Concomitant antimicrobial stewardship remains important in patients being treated for CDI and shortly after treatment.
Insights
Concomitant antibiotics given during or after Clostridioides difficile infection (CDI) treatment significantly increase the risk of CDI recurrence. Careful antimicrobial stewardship is crucial to prevent further CDI episodes and manage the infection effectively.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Clostridioides difficile infection (CDI) is a significant healthcare-associated infection.
- Antibiotic use is the primary risk factor for developing CDI.
- Patients with CDI often require concurrent antibiotic therapy for other conditions.
Purpose of the Study:
- To evaluate the impact of concomitant antibiotic use on the recurrence of CDI (rCDI).
- To assess rCDI rates in patients receiving antibiotics during or after CDI treatment.
Main Methods:
- Retrospective review of inpatient CDI cases.
- Patients categorized based on concomitant antibiotic exposure: noABx, ABxDURING, ABxAFTER, ABxDuringAfter.
- Primary outcome: CDI recurrence within 14-90 days; secondary outcomes included ICU stay, colectomy, and readmission.
Main Results:
- 64.1% of 457 CDI patients received concomitant antibiotics.
- Recurrence rates were 4.3% (noABx), 6.1% (ABxDURING), 13.8% (ABxAFTER), and 19.1% (ABxDuringAfter).
- Concomitant antibiotic use during and after CDI treatment (ABxDuringAfter) significantly increased rCDI risk (OR 5.67).
Conclusions:
- High utilization of non-CDI antibiotics during or shortly after CDI treatment is associated with elevated recurrence rates.
- Concomitant antimicrobials disrupt gut microbiota recovery, exacerbating dysbiosis and increasing rCDI.
- Antimicrobial stewardship is essential for managing CDI and preventing recurrence.
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