Antimicrobial exposure time related to clinical outcomes in C. difficile
Recent data suggest that people with Clostridium difficile who had a long duration of exposure to antimicrobial treatments other than those for C. difficile were at risk for adverse clinical outcomes related to their infection.
“Promptly discontinuing treatment with the C. difficile-promoting antimicrobials, although intuitive in the prevention of C. difficile, may not always be possible in the setting of concurrent infection,” researchers from Memorial Hospital of Rhode Island wrote. “Studies of the use of systemic, non-C. difficile-related antimicrobials in the setting of active C. difficile are sparse.”
The researchers conducted a retrospective cohort study in which they reviewed the medical records of all patients with C. difficile from 2008 to 2009. They identified patient characteristics such as comorbidities, history of C. difficile and hospitalizations within the previous 30 days, among others. They then determined the type and duration of antimicrobials used.
The study included 94 patients who were hospitalized and had a positive stool sample within 72 hours of hospitalization. Of these, 58 had received antimicrobials not related to C. difficile during their hospitalizations. The mean duration of exposure to these antimicrobials was 2.7 days. Among the 58 patients, the use of antimicrobials was considered unnecessary in 31. In 20 of these, no other infection, aside from C. difficile, was found.
Severe, complicated C. difficile infection, duration of antimicrobial exposure, and age were associated with adverse clinical outcomes. Patients who had sepsis at admission or who were suspected to have a urinary tract infection were most likely to receive unnecessary antimicrobial treatment.
“Focusing antimicrobial stewardship efforts on avoiding unnecessary antimicrobial exposure for hospitalized patients with C. difficile could prove beneficial,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.