February 27, 2019
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Patients with sickle cell disease may have lower risk for C. difficile

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Seah H. Lim, MD, PhD
Seah H. Lim

Findings from a retrospective cohort study conducted at a single hospital suggest that patients with sickle cell disease have a lower — and not higher — risk for Clostridioides difficile infection compared with the hospitalwide patient population, researchers reported in The New England Journal of Medicine.

In introducing their study, Seah H. Lim, MD, PhD, and colleagues from New York Medical College said health care-associated C. difficile infections “might be expected to be more common” in patients with sickle cell disease, and not less common, as the study found.

“Patients with sickle cell disease have defects in immune function; they are frequently hospitalized for painful vaso-occlusive crisis and are often given empirical antibiotic treatment for fever in this setting. They also have intestinal dysbiosis,” they wrote.

Lim and colleagues conducted their study at Westchester Medical Center in Valhalla, New York, between January 2015 and November 2018. They included 106 patients with a median age of 26 years, representing 365 total consecutive hospital admissions.

According to the study, the mean length of hospital stay was 10.2 days and the total number of patient days spent in the hospital was 3,727. During 180 hospitalizations, 454 courses of antibiotics were administered, with the most frequently used agents being ceftriaxone, azithromycin, vancomycin, piperacillin–tazobactam and cefepime, the researchers noted.

For reference, Lim and colleagues highlighted other studies conducted in hospitalwide populations that showed incidence rates of 6.3, 8.5 and 9.3 cases per 10,000 patient-days among adult patients. At their institution, the annual incidence rates hospitalwide were 7 to 10.8 cases per 10,000 patient-days, and the combined incidence rate was 9.1 cases per 10,000 patient-days (95% CI, 7.3-11.1).

However, among patients with sickle cell disease, only one case of C. difficile infection was reported over 3,727 patient-days, for an incidence rate of 2.7 cases per 10,000 patient-days (95% CI, 1.8-3.9) — significantly lower compared with the hospitalwide patient population.

“Despite the very many risk factors, such as intestinal dysbiosis, repeated hospitalizations, and frequent use of antibiotics, the intestine in sickle cell patients confers a protective effect against C. difficile infection,” Lim told Infectious Disease News. “Further knowledge into the mechanisms may provide important translational information to devise novel approaches to reducing the risks for C. difficile infections in other high-risk patient groups.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.