Corticosteroid use is associated with a reduced incidence of Clostridium difficile-associated diarrhea: A retrospective cohort study

Wojciechowski, Amy L.; Parameswaran, G. Iyer; Mattappallil, Arun; Mergenhagen, Kari A.

doi:10.1016/j.anaerobe.2014.07.010

Cited by 8 publications

(12 citation statements)

References 12 publications

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“…Wojciechowski and colleagues reported a reduced risk of CDI for patients with a COPD diagnosis and when systemic corticosteroids were used during antimicrobial treatment (36). This was corroborated by the findings of the present study, whereby COPD was statistically significantly associated with a reduced risk of CDI.…”

Section: Discussionsupporting

confidence: 89%

“…This was corroborated by the findings of the present study, whereby COPD was statistically significantly associated with a reduced risk of CDI. Wojciechowski and colleagues argued that corticosteroids attenuate the host immune response to C. difficile toxins, thus reducing the toxin-induced cytokine release that is associated with systemic symptoms of CDI (36). Further studies are required to confirm the mechanism behind the association.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities

et al. 2017

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Clostridium difficile infection (CDI) is becoming less exclusively a health care-associated CDI (HA-CDI). The incidence of community-associated CDI (CA-CDI) has increased over the past few decades. It has been postulated that asymptomatic toxigenic C. difficile (TCD)-colonized patients may play a role in the transfer of C. difficile between the hospital setting and the community. Thus, to investigate the relatedness of C. difficile across the hospital and community settings, we compared the characteristics of symptomatic and asymptomatic host patients and the pathogens from these patients in these two settings over a 3-year period. Two studies were simultaneously conducted; the first study enrolled symptomatic CDI patients from two tertiary care hospitals and the community in two Australian states, while the second study enrolled asymptomatic TCD-colonized patients from the same tertiary care hospitals. A total of 324 patients (96 with HA-CDI, 152 with CA-CDI, and 76 colonized with TCD) were enrolled. The predominant C. difficile ribotypes isolated in the hospital setting corresponded with those isolated in the community, as it was found that for 79% of the C. difficile isolates from hospitals, an isolate with a matching ribotype was isolated in the community, suggesting that transmission between these two settings is occurring. The toxigenic C. difficile strains causing symptomatic infection were similar to those causing asymptomatic infection, and patients exposed to antimicrobials prior to admission were more likely to develop a symptomatic infection (odds ratio, 2.94; 95% confidence interval, 1.20 to 7.14). Our findings suggest that the development of CDI symptoms in a setting without establishment of hospital epidemics with binary toxin-producing C. difficile strains may be driven mainly by host susceptibility and exposure to antimicrobials, rather than by C. difficile strain characteristics.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities

et al. 2017

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“…As a preventive measure, Wojciechowski et al examined the impact of corticosteroid use on the incidence of CDAD in patients receiving antibiotic treatment for respiratory infections. The use of corticosteroids was associated with a decreased incidence of CDAD (OR: 0.12; 95% CI: 0.006 - 0.95) [19]. …”

Section: Discussionmentioning

confidence: 99%

Lack of Association Between the Clinical Outcome of Clostridium difficile Infection and Current Steroids Use

et al. 2017

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BackgroundThe purpose of this study was to compare the outcome of Clostridium difficile infection (CDI) in patients on systemic steroids for various indications to patients not on steroids in term of disease severity, and associated morbidity and mortality.MethodsWe retrospectively reviewed records of all patients with CDI at our hospital from January 2011 to December 2016. Patients were evaluated for baseline characteristics, comorbidities, medications, disease severity, disease-related length of stay (LOS) from the diagnosis of CDI to discharge, need for surgical intervention, and disease-related mortality. Based on systemic steroids use, patients who were using steroids for different indications constituted the study population, and those with no steroids use were clustered as a control group.ResultsOf the 258 patients included, males were 127 (49%). Severe and severe-complicated CDI developed in 21/63 (33.3%) and 1/63 (1.6%) of patients on steroids (average daily dose of 20 mg), and in 73/195 (37.4%) and 5/195 (2.6%) of patients with no steroids use (P = 0.56 and P = 0.66, respectively). Surgical intervention was not required in the steroids group and 5/195 (2.7%) of patients not on steroids underwent bowel surgeries (P = 0.38). Mean LOS (days) was 11.6 ± 1.5 in the steroids group and 10.4 ± 0.7 in the no-steroids group (P = 0.4). CDI-related mortality occurred in 9/63(14.3%) of patients on steroids, and in 15/195 (7.7%) of patients not on steroids (P = 0.12; odds ratio (OR): 2; 95% confidence interval (CI): 0.8 - 4.8).ConclusionThere was no significant difference in the severity of CDI, need for surgical interventions, disease-related LOS and mortality in systemic steroids users compared to patients not on steroids.

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“…Patients who underwent HSCT and did not develop CDI were also exposed to corticosteroids more often than patients who underwent HSCT and developed CDI. In a retrospective study, the effect of exposure to corticosteroids on the incidence of CDI was evaluated in patients receiving antibiotics for the treatment of respiratory infections . Corticosteroid use (intravenous or oral administration) during antibiotic treatment was more common in patients who did not develop CDI (53.6% vs 9.1%, p=0.004).…”

Section: Discussionmentioning

confidence: 99%

“…Exposure to corticosteroids results in decreased release of the inflammatory cytokines interleukin‐1 and ‐2, decreased phagocytic function of neutrophils, and decreased chemotaxis of eosinophils, monocytes, and neutrophils . Thus it is suggested that attenuating the inflammatory response may diminish intestinal injury and prevent clinical symptoms associated with CDI …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors forClostridium difficileInfection in Hematopoietic Stem Cell Transplant Recipients

et al. 2017

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Corticosteroid use is associated with a reduced incidence of Clostridium difficile-associated diarrhea: A retrospective cohort study

Cited by 8 publications

References 12 publications

Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities

Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities

Lack of Association Between the Clinical Outcome of Clostridium difficile Infection and Current Steroids Use

Evaluation of Risk Factors forClostridium difficileInfection in Hematopoietic Stem Cell Transplant Recipients

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