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Recurrent CDI linked with higher mortality, ED visits
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Patients with recurrent Clostridium difficile infections face more adverse consequences and have a higher 1-year mortality than patients with nonrecurrent infections or those who have never been infected, study data show.
Researchers emphasized the importance of finding new approaches to treating recurrent C. difficile infections.
“Management of recurrent CDI remains challenging. In response, considerable efforts have recently been dedicated to developing novel preventive and treatment strategies, including vaccines, monoclonal antibodies, such as bezlotoxumab, an investigational drug directed against the C. difficile toxin B, and fecal transplantation,” Jennifer L. Kuntz, PhD, of the Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, and colleagues wrote. “However, evidence of the impact of recurrent CDI on patient health care utilization and outcomes is limited. A better understanding of the consequences of recurrent CDI is particularly important when assessing the possible benefits and cost-effectiveness of novel therapies aimed at prevention among high-risk populations and treatment among those who develop recurrence.”
The researchers conducted a nested case-control study from Sept. 1, 2001 to Dec. 31, 2013 on adults in the Kaiser Foundation Health Plan, dividing patients into three groups: recurrent CDI (n = 4,174), nonrecurrent CDI (n = 24,122) and patients with no CDI (n = 4,334,214). Kuntz and colleagues performed three comparisons after matching patients for age, sex and comorbidity: recurrent CDI vs. no CDI, recurrent CDI vs. nonrecurrent CDI and nonrecurrent CDI vs. no CDI. They conducted follow-up at 1 year, and they compared health care use for each group. Mean age was 63.2 years in the nonrecurrent CDI group and no CDI group, and 68.8 years among the recurrent CDI group.
Kuntz and colleagues reported that after matching, the recurrent CDI group had a higher risk for ED visits (RR = 1.48; 95% CI, 1.4-1.57), more days in the hospital (RR = 1.65; 95% CI, 1.55-1.76), days in the ICU (RR = 1.3; 95% CI, 1.12-1.52) and greater 1-year mortality (RR = 2.55; 95% CI, 2.28-2.84) than the nonrecurrent CDI group. The recurrent CDI group spent almost 2 more days in the hospital than patients with nonrecurrent CDI (95% CI, 1.4-2.3), and 4 more days in the hospital than matched controls with no CDI (95% CI, 3.1-4.3).
“The optimal management of recurrent CDI is not established. Most health care providers follow the current guidelines and use the same antimicrobials indicated for treatment of an initial infection for a first recurrence. Increasingly, these regiments are being acknowledged as ineffective at treating recurrent CDI or reducing subsequent recurrence,” Kuntz and colleagues wrote. “Our study demonstrates the excess utilization associated with recurrent CDI and supports the need for strategies that classify patients by risk and identify which patients should receive new approaches to prevention and treatment, some of which are expensive, uncomfortable, or both.” – by Andy Polhamus
Disclosure: Kuntz reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.
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