Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Abstract

Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

Introduction to the Special Issue on Clostridioides difficile

“…Moreover, the authors proposed a model of four predictors (age, days of admission, Charlson index, Child-Pugh score) to assess the risk of CDI in cirrhotic patients. Of note, in this study, cirrhotic patients with CDI had significantly higher costs compared with those without CDI [14].…”

“…This retrospective cohort study included 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed to have CDI. The authors reported that a higher age, longer hospital stay, higher level of urea, higher Charlson index, and the use of proton pump inhibitors were risk factors for CDI in cirrhotic patients [14]. Moreover, the authors confirmed that the MELD score was a predictor for mortality in cirrhotic patients with CDI.…”

“…Considering this, variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. The study by Voicu et al aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding and the mortality risk in this patient population [14]. This retrospective cohort study included 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed to have CDI.…”

Clostridioides difficile Infection in Liver Cirrhosis: A Concise Review

“…In a further over six years study, CDI incidence was 11.8% in 388 cirrhotic patients, and notably, 30.8% of the cirrhotic patients received the antibiotic rifaximin to prevent HE [ 38 ]. In a study of patients with variceal bleeding, also conducted in Romania, the incidence of CDI was 6.8% between 2017 and 2019 [ 39 ]. Finally, in another hospital in China, the Infectious Diseases Department reported 26 cases of CDI in 526 cirrhotic inpatients over six months in 2015 (4.9%) [ 4 ].…”

Resident-Related Factors Influencing Antibiotic Treatment Decisions for Urinary Tract Infections in Dutch Nursing Homes

“…Unnecessary antibiotic prescriptions increase the risk of adverse events at the individual level (such as Clostridium difficile infections and allergies [ 7 , 8 ]) and at the global level through antimicrobial resistance (AMR) development. AMR is highly prevalent in long-term care settings such as nursing homes, including resistance against commonly used antimicrobials to treat UTIs [ 4 , 5 , 9 ].…”