Opioid Use in Clostridium difficile Infection Is Associated With Worse Outcomes

Abstract

Introduction: Incidence and severity of Clostridium difficile infection (CDI) is increasing in North America. Identification of potentially modifiable risk factors may help improve outcomes. Inpatient use of opioids is common, either as continuation of outpatient opioids or newly prescribed. Opioid analgesics produce antimotility effects in the gastrointestinal tract favorable to bacterial growth. Despite these known pharmacologic properties, there is limited data on the impact of opioid use in CDI. Our purpose was to assess outcomes of CDI patients exposed to opioids vs those not exposed. Methods: A retrospective chart review of all inpatients diagnosed with CDI, during a two-year study period was performed. Exclusion criteria were age < 18 years and history of inflammatory bowel disease. Patients were divided into two groups based on the opioid exposure: the opioid group consisted of patients who were exposed to opioids, inpatient or outpatient. The non-opioid group consisted of patients who had no exposure to opioids. The severity of CDI was categorized as per Infectious Disease Society of America (IDSA) guidelines into mild-moderate and severe. Comparisons were analyzed with chi-square and t-test. Multivariate analysis was performed using logistic regression. Results: A total of 428 hospitalized patients diagnosed with CDI were included in the study. Of these, 325 (76%) patients were in the opioid group, and 103 (24.0%) patients were in the non-opioid group. Mean age of the patients was significantly lower in the opioid group (65.5 yrs vs 75.3 yrs, p=0.0001). Otherwise, there were no significant differences in patient demographics and comorbidities in the opioid group as compared to the non-opioid group Table 1. Mean length of stay was significantly higher in the opioid group (16.2 days) as compared to non-opioid group (10.3 days, P=0.0001). Readmission rate was higher for opiod group (32.7 % vs 22.1 %, p=0.05) with a trend towards significance. More patients in the opioid group had severe CDI (67.1%) than non-opioid group (55.0%, P=0.03). Thirty-day mortality was higher in the opioid group (28.1% vs 19.6%) but was not statistically significant (P=0.09). Conclusion: Majority of patients with CDI receive opioids. Use of opioids is associated with an increased risk of severe CDI and extended length of hospitalization. Opioid use in patients with CDI should be avoided. Limitations include single-center retrospective data. Further, large studies are needed to validate our findings.154_A Figure 1. Comparison of Baseline Patient Characteristics between the Opioid group and the Non-opioid group154_B Figure 2. Comparison of patient outcomes between the opioid and non-opioid group