Improving Clostridioides difficile Infectious Disease Treatment Response via Adherence to Clinical Practice...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Clostridioides difficile (C. difficile) is a major cause of hospital-acquired infections.
• Current clinical practice guidelines for C. difficile infectious disease (CDID) diagnosis and treatment were updated in 2017.
• Evaluating treatment concordance with guidelines is essential for optimizing patient outcomes.

Purpose of the Study:

• To assess clinical and laboratory characteristics of CDID.
• To determine the association between CDID characteristics and patient outcomes.
• To evaluate the impact of treatment concordance with 2017 guidelines on CDID outcomes.

Main Methods:

• Retrospective 10-year cohort study at a Lithuanian university hospital.
• Inclusion of 370 patients with primary CDID.
• Analysis of treatment concordance, clinical data, laboratory markers, and patient outcomes (ICU admission, mortality, survival).

Main Results:

• Non-concordant CDID treatment led to significantly higher CDID-related ICU admissions (7.5% vs 1.8%), CDID-related mortality (13.0% vs 1.8%), and 30-day all-cause mortality (61.0% vs 36.1%).
• Severe CDID cases treated non-concordantly with metronidazole showed higher rates of refractory disease (68.8%) and worse outcomes compared to vancomycin.
• Severe comorbidities and continued concomitant antibiotics worsened 30-day survival and increased 30-day all-cause mortality.

Conclusions:

• Treatment non-concordant with CDID guidelines is associated with adverse outcomes, including increased mortality and ICU admissions.
• For severe CDID (leukocytes ≥ 15 × 10^9/L, creatinine > 133 µmol/L), enteral vancomycin is recommended over metronidazole to prevent refractory disease.
• Severe comorbidities negatively impact survival; concomitant antibiotics should be carefully managed to reduce mortality.