Abstract
BackgroundClostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; however, limited data are available on the duration of exposure prior to CDI. Moreover, studies on the characteristics of CDI patients in Saudi Arabia are limited. Therefore, this study aimed to characterize CDI patients identified over 10 years and assess antibiotic days of therapy (DOT) prior to CDI.MethodsThis was a retrospective descriptive analysis of CDI patients at a Saudi tertiary academic medical center between December 2007 and January 2018. Patients characteristics, prior exposure to known CDI risk factors, and DOT of antibiotics prior to CDI incidence were assessed.ResultsA total of 159 patients were included. Median age was 62 years. Most cases were hospital-acquired (71.1%), non-severe (44.7%), and admitted to medical wards (81.1%). Prior exposure to antibiotics and acid suppression therapy were reported with the majority (76.1 and 75.5%, respectively). The most frequently prescribed antibiotics were piperacillin/tazobactam, ceftriaxone, meropenem, and ciprofloxacin with median DOTs prior to CDI incidence of 14 days for the β-lactams and 26 days for ciprofloxacin. The distribution of DOT was significantly different for piperacillin/tazobactam in different units (P = 0.003) where its median DOT was the shortest in medical wards (11 days), and for ciprofloxacin among different severity groups (P = 0.013), where its median DOT was the shortest in severe CDI patients (11 days).ConclusionMost patients in this study had hospital-acquired non-severe CDI and were largely exposed to antibiotics and acid suppression therapy. Therefore, such therapies should be revised for necessity.
Highlights
Clostridioides difficile infection (CDI) is a common hospital-associated diarrhea
A similar pattern was seen with the exposure to acid suppression therapy, where 95 (84.1%), 9 (32.1%), and 16 (88.9%) of Hospital-onset Clostridioides difficile infection (HO-CDI), Community-acquired Clostridioides difficile infection (CA-CDI), and community-onset healthcare facility-associated (CO-HCFA) CDI patients, respectively, received a proton pump inhibitor or an H 2-receptor antagonist
These findings were consistent with our patient population that developed CO-HCFA CDI, but not with CA-CDI patients, where the majority of the former were exposed to antibiotic, acid-suppression therapy, or both
Summary
Clostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; limited data are available on the duration of exposure prior to CDI. Some patients with a recurrent CDI episode who get exposed to the healthcare system were found to acquire a strain of CDI that is different from the index strain that caused the initial episode [2] This finding adds to the evidence that one of the important modes of acquiring CDI is through hospitalization or exposure to healthcare by Alammari and Thabit Gut Pathog (2021) 13:10 other means, such as regular hemodialysis or residence in nursing homes. Certain risk factors are known to be associated with CDI, such as exposure to antibiotics, older age, use of acid-suppressing agents, and use of antineoplastic agents [3, 4] Identifying these risk factors in admitted patients can help predicting the risk of acquiring the infection; decreasing the exposure to modifiable factors, such as antibiotics and acid suppression therapy.
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