Possible link between clostridioides difficile infection and oral mucositis: insights from a large real-world dataset

Clostridioides difficile infection (CDI), the primary cause of antibiotic-associated diarrhea in the U.S., is typically gastrointestinal but may also present with extra-intestinal features such as oral mucositis. While this association has been noted in oncology populations, its occurrence in non-oncology patients remains unexplored. This study evaluates whether adults with CDI face an elevated risk of developing oral mucositis compared to matched controls without CDI.

A retrospective cohort study utilizing the TriNetX real-world dataset examined patients with confirmed CDI, excluding those with prior oral mucositis, leukemia, chemotherapy or radiotherapy exposure, and other major comorbidities to reduce confounding.

Among matched cohorts of over 227,000 individuals, the incidence of oral mucositis within 30 days post-diagnosis was notably higher in patients with CDI compared to controls (0.035% vs. 0.015%). This translates to an absolute risk difference of 0.019% and a statistically significant two-fold increased relative risk (2.26) (P < .0001), suggesting a potential association between CDI and oral mucositis.

Although the absolute risk is low, the significant relative risk suggests that oral mucositis may be an overlooked complication of CDI in non-oncology patients. These findings underscore the importance of incorporating routine oral health assessments into the care of patients with CDI.