Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate
Objective: Clostridioides difficile infection (CDI) may pose a serious threat to immunocompromised patients (IMC). Herein, we evaluated the clinical outcomes of IMC patients with CDI. Methods: All consecutive hospitalized patients between January 1, 2013 and December 31, 2018 with laboratory confirm...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-01-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971219304217 |
| _version_ | 1811325602594029568 |
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| author | Tomer Avni Tanya Babitch Haim Ben-Zvi Rabab Hijazi Gida Ayada Alaa Atamna Jihad Bishara |
| author_facet | Tomer Avni Tanya Babitch Haim Ben-Zvi Rabab Hijazi Gida Ayada Alaa Atamna Jihad Bishara |
| author_sort | Tomer Avni |
| collection | DOAJ |
| description | Objective: Clostridioides difficile infection (CDI) may pose a serious threat to immunocompromised patients (IMC). Herein, we evaluated the clinical outcomes of IMC patients with CDI. Methods: All consecutive hospitalized patients between January 1, 2013 and December 31, 2018 with laboratory confirmed CDI were included in the study. Subjects were divided into two groups: IMC patients and controls. Primary outcome was the recurrence rate of CDI (rCDI) at 30 and 90 days after the first CDI episode. Secondary outcomes included 30 and 90 day all-cause mortality, length of hospital stay (LOS) and readmission rates. A multivariate analysis adjusted other risk factors for recurrence. An analysis of IMC patient subgroups (based on type of IMC conditions) was also performed. Results are reported as odds ratios (OR) with a 95% confidence interval (95% CI). Results: A total of 573 patients were included, amongst them 149 IMC patients (36 solid organ transplants, 38 undergoing chemotherapy, 62 haematological conditions, 13 receiving high dose prednisone) and 424 controls. IMC patients were younger, independent and exhibited less significant comorbidities. On multivariable analysis, the rate of rCDI was significantly higher in IMC patients (OR 2.7, 95% CI 1.6–5). rCDI was also associated with vancomycin therapy, haemodialysis and previous hospitalizations. Mortality, LOS, CDI complications and rehospitalization rates were similar in both. Conclusions: IMC patients with CDI have an increased risk of 90 days rCDI. Vancomycin treatment for CDI endangers recurrence in IMC patients. Further research should explore other therapies for IMC patients with CDI with alternative agents such as Fidaxomicin and Bezlotoxumab. Keywords: Clostridioides difficile, Immunocompromised, Chemotherapy, Transplantations, Recurrence |
| first_indexed | 2024-04-13T14:37:13Z |
| format | Article |
| id | doaj.art-a7557b3997d544de93b56ad29fb09446 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-04-13T14:37:13Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-a7557b3997d544de93b56ad29fb094462022-12-22T02:43:01ZengElsevierInternational Journal of Infectious Diseases1201-97122020-01-0190237242Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rateTomer Avni0Tanya Babitch1Haim Ben-Zvi2Rabab Hijazi3Gida Ayada4Alaa Atamna5Jihad Bishara6Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Internal Medicine Department E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, IsraelInternal Medicine Department E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, IsraelClinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, IsraelInfectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Corresponding author at: Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, 49100, Israel.Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, IsraelObjective: Clostridioides difficile infection (CDI) may pose a serious threat to immunocompromised patients (IMC). Herein, we evaluated the clinical outcomes of IMC patients with CDI. Methods: All consecutive hospitalized patients between January 1, 2013 and December 31, 2018 with laboratory confirmed CDI were included in the study. Subjects were divided into two groups: IMC patients and controls. Primary outcome was the recurrence rate of CDI (rCDI) at 30 and 90 days after the first CDI episode. Secondary outcomes included 30 and 90 day all-cause mortality, length of hospital stay (LOS) and readmission rates. A multivariate analysis adjusted other risk factors for recurrence. An analysis of IMC patient subgroups (based on type of IMC conditions) was also performed. Results are reported as odds ratios (OR) with a 95% confidence interval (95% CI). Results: A total of 573 patients were included, amongst them 149 IMC patients (36 solid organ transplants, 38 undergoing chemotherapy, 62 haematological conditions, 13 receiving high dose prednisone) and 424 controls. IMC patients were younger, independent and exhibited less significant comorbidities. On multivariable analysis, the rate of rCDI was significantly higher in IMC patients (OR 2.7, 95% CI 1.6–5). rCDI was also associated with vancomycin therapy, haemodialysis and previous hospitalizations. Mortality, LOS, CDI complications and rehospitalization rates were similar in both. Conclusions: IMC patients with CDI have an increased risk of 90 days rCDI. Vancomycin treatment for CDI endangers recurrence in IMC patients. Further research should explore other therapies for IMC patients with CDI with alternative agents such as Fidaxomicin and Bezlotoxumab. Keywords: Clostridioides difficile, Immunocompromised, Chemotherapy, Transplantations, Recurrencehttp://www.sciencedirect.com/science/article/pii/S1201971219304217 |
| spellingShingle | Tomer Avni Tanya Babitch Haim Ben-Zvi Rabab Hijazi Gida Ayada Alaa Atamna Jihad Bishara Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate International Journal of Infectious Diseases |
| title | Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate |
| title_full | Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate |
| title_fullStr | Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate |
| title_full_unstemmed | Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate |
| title_short | Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate |
| title_sort | clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate |
| url | http://www.sciencedirect.com/science/article/pii/S1201971219304217 |
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