Continuation of anti-tuberculosis therapy after Clostridioides difficile infection: a retrospective cohort study

Clostridioides difficile infection (CDI) sometimes complicates tuberculosis (TB) treatment, but whether anti-TB therapy should be continued after CDI is unclear. We evaluated clinical outcomes according to whether anti-TB therapy was continued or discontinued after CDI onset.

We retrospectively reviewed hospitalized TB patients who developed CDI at National Hospital Organization Tokyo National Hospital between January 2015 and March 2025. We compared clinical characteristics, CDI outcomes, and TB-related outcomes between patients who continued and those who discontinued anti-TB therapy after CDI diagnosis.

Among 3819 TB admissions, 47 patients met inclusion criteria. Median age was 85 years, and most CDI episodes were non-severe. Anti-TB therapy was continued in 32 patients (68.1%) and discontinued in 15 (31.9%). CDI treatment failure or recurrence was less frequent in the continuation group (6.3% vs 40%, p = 0.009). Time to sputum smear and culture conversion, length of stay, and in-hospital mortality did not differ between groups. Advanced age and impaired renal function were associated with CDI treatment failure or recurrence.

In this cohort, continuing anti-TB therapy after CDI diagnosis was not associated with worse CDI outcomes and may be feasible in patients with a favorable risk profile.