Impact of Clostridioides difficile length of treatment on rates of recurrence in patients on concurrent antibiotics

Irina Rajakumar; Rami Jaber; Raafi Ali; Elissa Rennert-May; Deana Sabuda

doi:10.1016/j.ajic.2023.04.167

Impact of Clostridioides difficile length of treatment on rates of recurrence in patients on concurrent antibiotics

Am J Infect Control. 2023 Apr 25:S0196-6553(23)00336-X. doi: 10.1016/j.ajic.2023.04.167. Online ahead of print.

Authors

Irina Rajakumar¹, Rami Jaber², Raafi Ali³, Elissa Rennert-May⁴, Deana Sabuda³

Affiliations

¹ Department of Pharmacy, Foothill Medical Center, Alberta Health Services, Calgary, Alberta, Canada. Electronic address: irina.rajakumar@ahs.ca.
² Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
³ Department of Pharmacy, Foothill Medical Center, Alberta Health Services, Calgary, Alberta, Canada.
⁴ Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

PMID: 37105356
DOI: 10.1016/j.ajic.2023.04.167

Abstract

Background: Clostridioides difficile infection (CDI) is principally health care-associated, with a substantial impact on morbidity and mortality. The guidelines recommend CDI therapy for 10 days; however, it is often extended in practice when concurrent antibiotics are used. The impact of the extended duration of therapy remains unclear.

Objective: To compare the rates of CDI recurrence in patients receiving standard duration of therapy (SDT) with those receiving extended duration of therapy (EDT) for the treatment of hospital-acquired CDI (HA-CDI) while receiving concurrent antibiotics.

Methods: A retrospective chart review was conducted between October 2017 and 2019. Adult HA-CDI patients who received a minimum 10 days of CDI therapy and were on concurrent antibiotics were stratified into SDT and EDT groups. Rates of CDI recurrence (at 90 and 180 days) and incidence of new-onset vancomycin-resistant enterococcus (VRE) were compared.

Results: Two hundred twenty-three patients met the inclusion criteria (SD-106, EDT-117). CDI recurrence rates at 90 and 180 days were not statistically significant between SDT and EDT groups (22% vs 26%, P = .40% and 26% vs 31%, P = .47). Although the incidence of VRE within the extended group was higher, it was not statistically significant (6% vs 9%, P = .29).

Conclusions: No significant difference in rates of recurrence or new-onset VRE was observed between SDT and EDT in HA-CDI patients.

Keywords: Antimicrobial stewardship; Clostridioides difficile infection; Concurrent antimicrobials; Infection control.