First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and Within 30 Days of Treatment
Background Clostridioides difficile infection (CDI) is an epidemic with the strongest risk factor being antibiotic usage. Patients who get CDI frequently require concomitant antibiotics for other indications around the time of their infection. Aims To assess the recurrence of CDI (rCDI) in patients...
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| Veröffentlicht in: | Digestive diseases and sciences 2023-11, Vol.68 (11), p.4221-4229 |
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| creator | Chaar, Abdelkader Damianos, John Rizwan, Rabia Al-Nahhas, Houssam Mansoor, Muhammad Sohail Sharma, Prabin Malik, Umer Feuerstadt, Paul |
| description | Background
Clostridioides difficile
infection (CDI) is an epidemic with the strongest risk factor being antibiotic usage. Patients who get CDI frequently require concomitant antibiotics for other indications around the time of their infection.
Aims
To assess the recurrence of CDI (rCDI) in patients receiving concomitant antibiotics at the same time or shortly thereafter treatment of CDI.
Methods
We retrospectively reviewed records for patients with their first inpatient CDI episode. Patients were grouped into those who didn’t receive concomitant antibiotics (noABx), those receiving antibiotics at the same time as treatment of CDI (ABxDURING), those receiving antibiotics within 30-days of completion of CDI therapy (ABxAFTER) and those who received antibiotics both during and after CDI treatment (ABxDuringAfter). Our primary outcome was recurrence within 14–90 days; other outcomes included ICU stay at the time of diagnosis, 30-day ICU transfer, 30-day colectomy, and readmission.
Results
457 patients had CDI during admission (mean age: 66.4 years, 51.9% female). 64.1% were exposed to concomitant antibiotics. Recurrence rates were 4.3%, 6.1%, 13.8% and 19.1%, for noABx, ABxDURING, ABxAFTER and ABxDuringAfter, respectively. Patients with ABxDuringAfter had the highest rates of rCDI when compared to noABx [OR 5.67, 95% CI (2.18–14.72)].
Conclusions
There is a high rate of utilization of non-CDI antibiotics during or shortly after completing CDI treatment with high rates of recurrence within 90-days. Concomitant antimicrobials alter the opportunity for the microbiota to re-grow and worsens dysbiosis leading to increases in recurrence. Concomitant antimicrobial stewardship remains important in patients being treated for CDI and shortly after treatment.
Graphical Abstract |
| doi_str_mv | 10.1007/s10620-023-08091-0 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2860617209</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A768766126</galeid><sourcerecordid>A768766126</sourcerecordid><originalsourceid>FETCH-LOGICAL-c370t-10eefb8e7ac902c527d9cfa0076b5eac1059ab59c2832f56ff3b1ac4d2be83583</originalsourceid><addsrcrecordid>eNp9kUFr3DAQhU1pods0f6AnQS-9OBlJtWwfl003CQQKJSVHIcujzQRb2koyJX-iv7nabCC0lKLD6PC9x8x7VfWBwxkHaM8TByWgBiFr6KDnNbyqVrxpZS0a1b2uVsBV-XOu3lbvUnoAgL7lalX92lJMmW2mkHKkkQKNmNhIzpGlCdk3tEuM6C2y68SuaHePBd-GaQo_ye_YJngbZsrGZ7b2mWayMQxkJrYeZ_JUXE2m4NnFEg-88SO7o3xPnklgF-YxseDYbUSTZ_T5ffXGmSnh6fM8qb5vv9xuruqbr5fXm_VNbWULueaA6IYOW2N7ELYR7dhbZ0oSamjQWA5Nb4amt6KTwjXKOTlwYz-PYsBONp08qT4dffcx_FjKSXqmZHGajMewJC06BYq3AvqCfvwLfQhL9GW7QrWKd1xC90LtzISavAvlcHsw1etWFU5xoQp19g-qvBFLcMGjK5n_KRBHQUk1pYhO7yPNJj5qDvrQvD42r0vz-ql5DUUkj6K0P2SO8WXj_6h-A0n8sYI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2876181308</pqid></control><display><type>article</type><title>First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and Within 30 Days of Treatment</title><source>SpringerLink Journals - AutoHoldings</source><creator>Chaar, Abdelkader ; Damianos, John ; Rizwan, Rabia ; Al-Nahhas, Houssam ; Mansoor, Muhammad Sohail ; Sharma, Prabin ; Malik, Umer ; Feuerstadt, Paul</creator><creatorcontrib>Chaar, Abdelkader ; Damianos, John ; Rizwan, Rabia ; Al-Nahhas, Houssam ; Mansoor, Muhammad Sohail ; Sharma, Prabin ; Malik, Umer ; Feuerstadt, Paul</creatorcontrib><description>Background
Clostridioides difficile
infection (CDI) is an epidemic with the strongest risk factor being antibiotic usage. Patients who get CDI frequently require concomitant antibiotics for other indications around the time of their infection.
Aims
To assess the recurrence of CDI (rCDI) in patients receiving concomitant antibiotics at the same time or shortly thereafter treatment of CDI.
Methods
We retrospectively reviewed records for patients with their first inpatient CDI episode. Patients were grouped into those who didn’t receive concomitant antibiotics (noABx), those receiving antibiotics at the same time as treatment of CDI (ABxDURING), those receiving antibiotics within 30-days of completion of CDI therapy (ABxAFTER) and those who received antibiotics both during and after CDI treatment (ABxDuringAfter). Our primary outcome was recurrence within 14–90 days; other outcomes included ICU stay at the time of diagnosis, 30-day ICU transfer, 30-day colectomy, and readmission.
Results
457 patients had CDI during admission (mean age: 66.4 years, 51.9% female). 64.1% were exposed to concomitant antibiotics. Recurrence rates were 4.3%, 6.1%, 13.8% and 19.1%, for noABx, ABxDURING, ABxAFTER and ABxDuringAfter, respectively. Patients with ABxDuringAfter had the highest rates of rCDI when compared to noABx [OR 5.67, 95% CI (2.18–14.72)].
Conclusions
There is a high rate of utilization of non-CDI antibiotics during or shortly after completing CDI treatment with high rates of recurrence within 90-days. Concomitant antimicrobials alter the opportunity for the microbiota to re-grow and worsens dysbiosis leading to increases in recurrence. Concomitant antimicrobial stewardship remains important in patients being treated for CDI and shortly after treatment.
Graphical Abstract</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-023-08091-0</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Antibiotics ; Biochemistry ; Drug therapy ; Fidaxomicin ; Gastroenterology ; Health aspects ; Hepatology ; Infection ; Medicine ; Medicine & Public Health ; Metronidazole ; Microbiota (Symbiotic organisms) ; Oncology ; Original Article ; Risk factors ; Transplant Surgery</subject><ispartof>Digestive diseases and sciences, 2023-11, Vol.68 (11), p.4221-4229</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>COPYRIGHT 2023 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c370t-10eefb8e7ac902c527d9cfa0076b5eac1059ab59c2832f56ff3b1ac4d2be83583</cites><orcidid>0000-0002-7643-9576</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-023-08091-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-023-08091-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Chaar, Abdelkader</creatorcontrib><creatorcontrib>Damianos, John</creatorcontrib><creatorcontrib>Rizwan, Rabia</creatorcontrib><creatorcontrib>Al-Nahhas, Houssam</creatorcontrib><creatorcontrib>Mansoor, Muhammad Sohail</creatorcontrib><creatorcontrib>Sharma, Prabin</creatorcontrib><creatorcontrib>Malik, Umer</creatorcontrib><creatorcontrib>Feuerstadt, Paul</creatorcontrib><title>First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and Within 30 Days of Treatment</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><description>Background
Clostridioides difficile
infection (CDI) is an epidemic with the strongest risk factor being antibiotic usage. Patients who get CDI frequently require concomitant antibiotics for other indications around the time of their infection.
Aims
To assess the recurrence of CDI (rCDI) in patients receiving concomitant antibiotics at the same time or shortly thereafter treatment of CDI.
Methods
We retrospectively reviewed records for patients with their first inpatient CDI episode. Patients were grouped into those who didn’t receive concomitant antibiotics (noABx), those receiving antibiotics at the same time as treatment of CDI (ABxDURING), those receiving antibiotics within 30-days of completion of CDI therapy (ABxAFTER) and those who received antibiotics both during and after CDI treatment (ABxDuringAfter). Our primary outcome was recurrence within 14–90 days; other outcomes included ICU stay at the time of diagnosis, 30-day ICU transfer, 30-day colectomy, and readmission.
Results
457 patients had CDI during admission (mean age: 66.4 years, 51.9% female). 64.1% were exposed to concomitant antibiotics. Recurrence rates were 4.3%, 6.1%, 13.8% and 19.1%, for noABx, ABxDURING, ABxAFTER and ABxDuringAfter, respectively. Patients with ABxDuringAfter had the highest rates of rCDI when compared to noABx [OR 5.67, 95% CI (2.18–14.72)].
Conclusions
There is a high rate of utilization of non-CDI antibiotics during or shortly after completing CDI treatment with high rates of recurrence within 90-days. Concomitant antimicrobials alter the opportunity for the microbiota to re-grow and worsens dysbiosis leading to increases in recurrence. Concomitant antimicrobial stewardship remains important in patients being treated for CDI and shortly after treatment.
Graphical Abstract</description><subject>Antibiotics</subject><subject>Biochemistry</subject><subject>Drug therapy</subject><subject>Fidaxomicin</subject><subject>Gastroenterology</subject><subject>Health aspects</subject><subject>Hepatology</subject><subject>Infection</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metronidazole</subject><subject>Microbiota (Symbiotic organisms)</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Risk factors</subject><subject>Transplant Surgery</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUFr3DAQhU1pods0f6AnQS-9OBlJtWwfl003CQQKJSVHIcujzQRb2koyJX-iv7nabCC0lKLD6PC9x8x7VfWBwxkHaM8TByWgBiFr6KDnNbyqVrxpZS0a1b2uVsBV-XOu3lbvUnoAgL7lalX92lJMmW2mkHKkkQKNmNhIzpGlCdk3tEuM6C2y68SuaHePBd-GaQo_ye_YJngbZsrGZ7b2mWayMQxkJrYeZ_JUXE2m4NnFEg-88SO7o3xPnklgF-YxseDYbUSTZ_T5ffXGmSnh6fM8qb5vv9xuruqbr5fXm_VNbWULueaA6IYOW2N7ELYR7dhbZ0oSamjQWA5Nb4amt6KTwjXKOTlwYz-PYsBONp08qT4dffcx_FjKSXqmZHGajMewJC06BYq3AvqCfvwLfQhL9GW7QrWKd1xC90LtzISavAvlcHsw1etWFU5xoQp19g-qvBFLcMGjK5n_KRBHQUk1pYhO7yPNJj5qDvrQvD42r0vz-ql5DUUkj6K0P2SO8WXj_6h-A0n8sYI</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Chaar, Abdelkader</creator><creator>Damianos, John</creator><creator>Rizwan, Rabia</creator><creator>Al-Nahhas, Houssam</creator><creator>Mansoor, Muhammad Sohail</creator><creator>Sharma, Prabin</creator><creator>Malik, Umer</creator><creator>Feuerstadt, Paul</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7643-9576</orcidid></search><sort><creationdate>20231101</creationdate><title>First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and Within 30 Days of Treatment</title><author>Chaar, Abdelkader ; Damianos, John ; Rizwan, Rabia ; Al-Nahhas, Houssam ; Mansoor, Muhammad Sohail ; Sharma, Prabin ; Malik, Umer ; Feuerstadt, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-10eefb8e7ac902c527d9cfa0076b5eac1059ab59c2832f56ff3b1ac4d2be83583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Antibiotics</topic><topic>Biochemistry</topic><topic>Drug therapy</topic><topic>Fidaxomicin</topic><topic>Gastroenterology</topic><topic>Health aspects</topic><topic>Hepatology</topic><topic>Infection</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metronidazole</topic><topic>Microbiota (Symbiotic organisms)</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Risk factors</topic><topic>Transplant Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaar, Abdelkader</creatorcontrib><creatorcontrib>Damianos, John</creatorcontrib><creatorcontrib>Rizwan, Rabia</creatorcontrib><creatorcontrib>Al-Nahhas, Houssam</creatorcontrib><creatorcontrib>Mansoor, Muhammad Sohail</creatorcontrib><creatorcontrib>Sharma, Prabin</creatorcontrib><creatorcontrib>Malik, Umer</creatorcontrib><creatorcontrib>Feuerstadt, Paul</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaar, Abdelkader</au><au>Damianos, John</au><au>Rizwan, Rabia</au><au>Al-Nahhas, Houssam</au><au>Mansoor, Muhammad Sohail</au><au>Sharma, Prabin</au><au>Malik, Umer</au><au>Feuerstadt, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and Within 30 Days of Treatment</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><date>2023-11-01</date><risdate>2023</risdate><volume>68</volume><issue>11</issue><spage>4221</spage><epage>4229</epage><pages>4221-4229</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>Background
Clostridioides difficile
infection (CDI) is an epidemic with the strongest risk factor being antibiotic usage. Patients who get CDI frequently require concomitant antibiotics for other indications around the time of their infection.
Aims
To assess the recurrence of CDI (rCDI) in patients receiving concomitant antibiotics at the same time or shortly thereafter treatment of CDI.
Methods
We retrospectively reviewed records for patients with their first inpatient CDI episode. Patients were grouped into those who didn’t receive concomitant antibiotics (noABx), those receiving antibiotics at the same time as treatment of CDI (ABxDURING), those receiving antibiotics within 30-days of completion of CDI therapy (ABxAFTER) and those who received antibiotics both during and after CDI treatment (ABxDuringAfter). Our primary outcome was recurrence within 14–90 days; other outcomes included ICU stay at the time of diagnosis, 30-day ICU transfer, 30-day colectomy, and readmission.
Results
457 patients had CDI during admission (mean age: 66.4 years, 51.9% female). 64.1% were exposed to concomitant antibiotics. Recurrence rates were 4.3%, 6.1%, 13.8% and 19.1%, for noABx, ABxDURING, ABxAFTER and ABxDuringAfter, respectively. Patients with ABxDuringAfter had the highest rates of rCDI when compared to noABx [OR 5.67, 95% CI (2.18–14.72)].
Conclusions
There is a high rate of utilization of non-CDI antibiotics during or shortly after completing CDI treatment with high rates of recurrence within 90-days. Concomitant antimicrobials alter the opportunity for the microbiota to re-grow and worsens dysbiosis leading to increases in recurrence. Concomitant antimicrobial stewardship remains important in patients being treated for CDI and shortly after treatment.
Graphical Abstract</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s10620-023-08091-0</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7643-9576</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2023-11, Vol.68 (11), p.4221-4229 |
| issn | 0163-2116 1573-2568 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Antibiotics Biochemistry Drug therapy Fidaxomicin Gastroenterology Health aspects Hepatology Infection Medicine Medicine & Public Health Metronidazole Microbiota (Symbiotic organisms) Oncology Original Article Risk factors Transplant Surgery |
| title | First Clostridioides difficile Recurrence Is Highest Following Concomitant Antimicrobial Administration During and Within 30 Days of Treatment |
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