Duration of patient treatment Clostridioides difficile In a recent study, infection with concomitant antibiotics did not affect recurrence rates.
A retrospective chart review study published in American Journal of Infection Controlincluded 223 adults who were treated for nosocomial CDI for at least 10 days while simultaneously receiving antibiotics at four hospitals in Calgary, Alberta between October 2017 and 2019.
Current guidelines recommend discontinuing concomitant antibiotics for other indications when possible to reduce the risk of CDI recurrence, but in this study, 40% of patients with hospital-acquired CDI I found out I was on antibiotic therapy. CDI treatment is regularly extended based on that and other factors.
The investigators analyzed CDI recurrence rates at 90 and 180 days in patients who received the standard treatment period (SDT) and those who received the extended treatment period (EDT). Participants were divided into her two groups, with 106 receiving standard-duration treatment for an average of 11 days and 117 for extended treatment for an average of 24 days.
“When we examined a cohort of patients with HA-CDI, we found no difference in CDI recurrence rates when comparing the SDT and EDT groups,” said Irina Rajakumar, BScPhm, ACPR, BCIDP, Alberta Health Services. The leading authors write: “Other studies on this topic have found similar results when looking at the effect of long-term treatment on CDI recurrence.”
The 90-day CDI recurrence rate was 22% in the SDT group and 26% in the EDT group (P = 0.40). At 180 days, the CDI recurrence rate he was 26% in the SDT group and 31% in the EDT group (P = 0.47). The incidence of new-onset vancomycin-resistant enterococci was also not statistically significant in 6% of the SDT group compared to 9% of the EDT group (P = 0.29).
“Overall, we found no evidence to support prolonging CDI therapy in patients taking concomitant antibiotics,” the authors concluded. “However, future studies in the form of randomized controlled trials may demonstrate the impact of CDI treatment duration on relapse rates, while balancing the risk of CDI between comparison groups by controlling for duration and type of concomitant antibiotics.” It’s useful for assessing impact.”
CDI is common in hospitalized patients taking broad-spectrum antibiotics and causes longer hospital stays and additional costs. In Canada, her CDI patient with a nosocomial infection would cost him an extra 5.6 days in the hospital and an additional cost of $18,386. About one-third of CDI cases are recurrent.
Although the overall burden of CDI is estimated to have decreased by 24% between 2011 and 2017, the disease remains a significant burden and a major focus of efforts to reduce healthcare-associated infections. increase.
Most current guidelines recommend treating primary CDI with oral vancomycin for 10 days. A recent study supports vancomycin as a secondary prophylaxis to prevent recurrent CDI in a patient with a history of her CDI in the past 3 months who has been receiving systemic antibiotics.
Other therapies for the prevention or treatment of recurrent CDI include Rebyota, the first FDA-approved fecal microbiota treatment, and VE303, a novel oral microbiota therapy under development by Vedanta Biosciences.