Comprehensive C difficile Infection Management Approach

Clostridioides difficile infection (CDI) requires multifaceted treatment, considering pharmaceutical interventions and patient experience, according to a study published in BMC Infectious Diseases.

“CDI has many unseen and underappreciated consequences that go far beyond gastrointestinal symptomology,” wrote Paul Feuerstadt, Division of Digestive Disease, PACT-Gastroenterology Center, Yale University School of Medicine in Hamden, CT, and coauthors.

The clinical landscape of CDI is changing, and CDI and recurrent CDI (rCDI) have a wide range of impacts on financial, social, and clinical outcomes. The incidence rate of health care-associated CDI is 57.9 cases per 100,000, indicating a decline in recent years. However, community-associated CDI has increased and doubled in the past decade. The incidence of community-acquired CDI is 63.3 cases per 100,000. rCDI is also rising, with data indicating recurrence accounts for 75,000 to 175,000 additional cases of CDI per year. CDI can range from an asymptomatic carrier state to a life-threatening colitis. CDI remains a significant threat to mortality, and the likelihood of complications is high. CDI and rCDI can affect a patient’s quality of life, impacting psychological, social, professional, and economic aspects.

The most important risk factor for CDI is antibiotic use. Patients who are female, older, have comorbidities, are immunosuppressed, have recently been hospitalized, and have a history of using corticosteroids, proton pump inhibitors, or lipid-lowering therapy are at an increased risk of CDI and rCDI. However, patients with community-acquired CDI tend to be younger and have no antibiotic exposure. Due to hospital costs, CDI and rCDI are associated with a significant economic burden.

“Clinical treatment and management need to be multifaceted and consider not just pharmaceutical intervention but a holistic approach to the patient’s experience both during and after CDI, acknowledging the potential psychological and social effects as well as identifying payment assistance programs, supportive services, and work medical leave options,” explained the study authors.

Reference

Feuerstadt P, Theriault N, Tillotson G. The burden of CDI in the United States: a multifactorial challenge. BMC Infect Dis. 2023;23:132. doi:10.1186/s12879-023-08096-0