Predictors of Clostridioides difficile recurrence across a national cohort of veterans in outpatient, acute, and long-term care settings

Appaneal, Haley J; Caffrey, Aisling R.; Beganovic, Maya; Avramovic, Sanja; LaPlante, Kerry L.

doi:10.1093/ajhp/zxz032

Cited by 26 publications

(30 citation statements)

References 59 publications

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“…Of note, some studies made a distinction between the moment PPI was started, i.e. prior to initial CDI episode or during/shortly after the initial episode (12,13,15,123,125,146,149,155); PPI prescribed during or shortly after initial CDI appears to be associated with an increased risk of rCDI (effect found in 6/7 studies in univariate analysis, and in 2/4 studies in multivariable analysis; low quality of evidence).…”

Section: Prognostic Factors For Recurrent CDImentioning

confidence: 99%

“…Eight studies reported on non-CDI antibiotic use after initial CDI diagnosis as a risk factor, but results were inconsistent (12,123,129,136,141,145,146,148); 4/6 studies found an association between non-CDI antibiotic use and rCDI in univariate analysis, and 2/5 studies in multivariable analysis. A high-quality prospective study showed no significant association between antibiotic use and rCDI in both uni-and multivariate analysis (136).…”

Section: Prognostic Factors For Recurrent CDImentioning

confidence: 99%

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GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

et al. 2021

Preprint

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BackgroundClostridioides difficile infection (CDI), its subsequent recurrences (rCDI), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Treatment consists of oral antibiotics. Fidaxomicin, bezlotoxumab and fecal microbiota transplantion (FMT) reduce the number of recurrences compared to vancomycin, but are more costly. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices.ObjectivesIn this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI.MethodsPubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. Study selection was performed by two independent reviewers on the basis of predefined selection criteria; conflicts were resolved by consensus. Cohort and case-control studies providing an analysis of clinical or laboratory data to predict sCDI/rCDI in patients ≥18 years diagnosed with CDI, were included. Risk of bias was assessed with the Quality in Prognostic Research (QUIPS) tool and the quality of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, modified for prognostic studies. Overview tables of prognostic factors were constructed to assess the number of studies and the respective direction of an association (positive, negative, or no association).Results and conclusions136 studies were included for final analysis. Higher age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were higher age, healthcare-associated CDI, prior hospitalization, PPIs started during/after CDI diagnosis and previous rCDI. Some variables that were found as risk factors for sCDI/rCDI in previous reviews were not confirmed in the current review, which can be attributed to differences in methodology. Risk stratification for sCDI/rCDI may contribute to a more personalized and optimal treatment for patients with CDI.

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Section: Prognostic Factors For Recurrent CDImentioning

confidence: 99%

Section: Prognostic Factors For Recurrent CDImentioning

confidence: 99%

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

et al. 2021

Preprint

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“…2 5 What is more, PPIs have recently been associated with a variety of severe adverse effects such as osteoporosis and associated fractures, hypomagnesemia, community-acquired pneumonia, Clostridium difficile colitis and cardiovascular morbidity. [6][7][8][9][10][11] Even though extensive studies have been investigated on the appropriateness of PPIs in Western countries, such data from China are still very limited. Thus, there is an urgent need to characterise the prescribing patterns and drug utilisation research, and to evaluate the appropriateness of the initiative of prescribing PPIs, so that rationality and cost-effectiveness could be improved in the future.…”

Section: Open Accessmentioning

confidence: 99%

Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: insights from a single-centred retrospective study

Liu

Zhu

et al. 2020

BMJ Open

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ObjectivesThis study aimed to characterise the prescribing patterns and evaluate the appropriateness of the prescribed proton pump inhibitors (PPIs) in adult patients via a review of electronic medical records in a single-centred hospital.DesignAll patients admitted to the outpatient department of Jinshan Hospital, Fudan University, Shanghai, between 1 January 2018 and 31 December 2018 were evaluated. Individuals aged 18 years or above and with at least one dispensing for PPIs were identified as PPI users. New PPI users were defined as a subject who did not receive any dispensing for PPIs in the year prior to the index date. Baseline characteristics of PPI users and their therapies were described by treatment indication, economic indicators and co-prescription, overall and separately.SettingThe prescription database was retrieved from the hospital information system of Jinshan Hospital, Fudan University.ResultsAmong 18 435 identified PPI users in 2018, 14 219 patients (aged 18 years or above) who had at least one dispensing PPIs were new users (77%), and among them, men accounted for 47%. The mean treatment duration was 23 days. Omeprazole was the most commonly prescribed drug. PPIs are inappropriately prescribed in 50% (13 589/25 850) of prescriptions. Prescription appropriateness analysis indicated that the unapproved indications for PPI new users accounted for 47%; among them, the proportion of gastritis diagnosis was 34%. The proportion of PPI new users with co-prescription of glucocorticosteroids (GCs) who have risk factors accounted for 24% and lower than other co-prescription. A majority of PPI users (73%) reported high-dose PPI prescription. The defined daily dose of oral pantoprazole was the highest, and injectable omeprazole had the highest defined daily cost. In contrast, only the drug utilisation index value of oral esomeprazole was less than 1.0.ConclusionThe results indicate the challenge of PPI use was accompanied by unapproved indications, frequent inappropriate co-prescription with GCs and excessive dosages. Efforts should be paid to promote rational use and ensure the choice of suitable PPI therapy in the future.

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“…Furthermore, a multicenter, randomized, double-blind, placebo-controlled, trial performed to assess the role of Lactobacilli and Bifidobacteria in the prevention of antibiotic-associated diarrhea and CDI in older inpatients failed to demonstrate a beneficial effect with probiotics [240]. Even, a recent study shows that the use of probiotics was associated with a higher risk of recurrence [241].…”

Section: Question 19 Can Probiotics Be Used To Prevent Recurrences?mentioning

confidence: 99%

Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spaish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

Bouza¹,

Aguado²,

Alcalá³

et al. 2020

Rev Esp Quimioter

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ned leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic

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Predictors of Clostridioides difficile recurrence across a national cohort of veterans in outpatient, acute, and long-term care settings

Cited by 26 publications

References 59 publications

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: insights from a single-centred retrospective study

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