5PSQ-108 Infection with Clostridium difficile: risk factors and pharmacotherapeutic management

• Published in: European journal of hospital pharmacy. Science and practice Vol. 27; no. Suppl 1; p. A199
• Main Authors: Sanchez Matamoros Piazza, MDV, Vazquez Vela, V, Mora Herrera, C, Puivecino Moreno, C, Varas Perez, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.03.2020
• Subjects: Antibiotics; Laxatives; Patients; Risk factors
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2020-eahpconf.425

Background and importanceThe incidence and severity of cases of Clostridium difficile infection (CDI) has been increasing, as well as hospital stays and hospitalisation costs.Aim and objectivesTo analyse the therapeutic approach of CDI and the contribution of risk factors.Material and methodsA retrospective observational study was conducted in patients with culture and/or positive toxins for CD during 2018. The information was obtained after review of the clinical histories of patients with CDI: demographic data, previous antibiotic treatment, risk factors (age, SNG, treatment with immunosuppressants, PPIs, laxatives, NSAIDs or IBD), severity of the episode, treatment established, subsequent recurrences (<4 months after treatment) and complications.ResultsThirty patients were included, 75.86% with a positive toxin. Average age was 64.12 years, 65.52% of patients were women and 96.55% had received previous antibiotic treatments (broad spectrum penicillins, cephalosporins and quinolones). Risk factors: 58.62% (17) >65 years, 82.76% (24) undergoing treatment with PPIs, 20.68% (6) NSAIDs,13.79% (4) laxatives, 31.03% (9) immunosuppressants,13.79% (4) had IBD and 10.34% (3) SNG.CDI were considered mild–moderate in 93.1% (28) of patients and severe in 6.9% (2). They were treated with vancomycin (68.97%), metronidazole (6.9%) and vancomycin/metronidazole (17.24%), and 2 were untreated. Most common pattern was vancomycin 250 mg/6 hours for an average of 14 days. One patient presented with toxicoderma after vancomycin and 10.3% (3) presented recurrences (0.5–3.5 months): 2 patients were treated with vancomycin/metronidazole, and after a new recurrence with vancomycin/fidaxomycin. In the other patient, bezlotuxumab/vancomycin was used first with a good resolution.In 79.31% (23) of patients their infectious condition was resolved satisfactorily. Three patients presented complications (two sepsis and one pseudomembranous colitis). The rest of the follow-up losses were due to transfer (3) and success for other reasons (1).Conclusion and relevanceThe majority of patients presented with mild–moderate CDI and vancomycin was used as usual therapy with good resolution. Risk factors included prior use of antibiotics, immunosuppressants and PPIs. It is essential to stratify patients according to severity and re-treat according to the previous episode.References and/or acknowledgementsNo conflict of interest.