By David Wild

Researchers have drawn a direct line between the number of Clostridioides difficile infection (CDI) episodes patients have and their likelihood of experiencing sepsis or requiring colorectal surgery. Their review of a national database showed 43% of individuals with three or more CDI recurrences experienced sepsis and more than 10% required colorectal surgery.

“While there is significant knowledge about the epidemiology and clinical manifestations of CDI, fewer clinical data exist from real-world analyses [about] complications of sepsis and bowel surgery, and the available data are not adequately generalizable to a broad U.S. population,” according to the researchers, led by Paul Feuerstadt, MD, an assistant clinical professor at Yale School of Medicine, in New Haven, Conn. (Sage Open Med 2021 Jan 14. doi:10.1177/2050312120986733).

Dr. Feuerstadt and his team sought to fill this gap by retrospectively analyzing a national claims database (IQVIA PharMetrics Plus). They found 46,571 adults with at least one CDI between 2010 and 2017. Patients were a mean 47 years of age at the time of index CDI and most were female.

CDI episodes were considered to have resolved after two weeks with no CDI-related claims, whereas recurrent CDI was defined as a CDI episode occurring within eight weeks of the two-week claim-free period after an initial CDI. The researchers found that most patients had one CDI episode, 6.7% of patients experienced a single CDI recurrence, 1% experienced two recurrences and 0.3% experienced three or more recurrences. Nearly all patients were treated with antibiotics, while 0.7% received fecal microbiota transplantation.

Those with recurrent CDI were more likely to have comorbidities, especially autoimmune conditions such as inflammatory bowel disease, the authors found.

Sepsis occurred in 16.5%, 27%, 33% and 43% of patients with zero, one, two, or at least three recurrences of CDI, respectively, during a 12-month follow-up period. No one had more than one episode of sepsis. CDI recurrence also was linked with an increased likelihood of undergoing subtotal colectomy or diverting loop ileostomy, with 4.6%, 7.3%, 8.9% and 10.5% of patients with zero, one, two or at least three recurrences, respectively, requiring these surgeries.

The authors acknowledged that database studies can miss important data but noted that despite the limitations of their study design, their data “provides a good cross-sectional view of a broad population in the United States who experienced CDI or [recurrent] CDI.”

They concluded that addressing “recurrent C. difficile infection is an important step to reduce the burden of serious clinical complications, and new treatments are needed to reduce C. difficile infection recurrence.”