Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate

• Published in: International journal of infectious diseases Vol. 90; pp. 237 - 242
• Main Authors: Avni, Tomer, Babitch, Tanya, Ben-Zvi, Haim, Hijazi, Rabab, Ayada, Gida, Atamna, Alaa, Bishara, Jihad
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.01.2020; Elsevier
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal - therapeutic use; Broadly Neutralizing Antibodies - therapeutic use; Chemotherapy; Clostridioides difficile; Clostridium difficile - classification; Clostridium difficile - drug effects; Clostridium difficile - genetics; Clostridium difficile - isolation & purification; Clostridium Infections - drug therapy; Clostridium Infections - immunology; Clostridium Infections - microbiology; Clostridium Infections - therapy; Female; Fidaxomicin - therapeutic use; Hospitalization; Humans; Immunocompromised; Immunocompromised Host; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Recurrence; Risk Factors; Transplantations; Vancomycin - therapeutic use; Recurrence; Clostridioides difficile; Chemotherapy; Transplantations; Immunocompromised
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2019.10.028

•There is an increased incidence of CDI in immunocompromised patients.•A higher recurrence rate of CDI was observed during 90 days after the first episode in immunocompromised patients.•One of the strong predictors of CDI recurrence was treatment with Vancomycin given at the first CDI episode.•Alternative therapy for first episode CDI in the immuocompromised patient should be considered (Fidaxomicin and Bezlotoxumab). Clostridioides difficile infection (CDI) may pose a serious threat to immunocompromised patients (IMC). Herein, we evaluated the clinical outcomes of IMC patients with CDI. 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). 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. 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.