Key Takeaways
- Researchers analyzed Clostridioides difficile episodes and identified the risk factors and potential medications that caused them.
- The study's results showed a need to improve both CDI management and diagnosis.
Diagnostic Accuracy, Antibiotic Use Must Be Improved in C. Diff Infections
In an abstract presented at Digestive Disease Week 2024, researchers analyzed Clostridioides difficile episodes and identified the risk factors and potential medications that caused them.
Patients with Clostridioides difficle infection (CDI) are more likely to be mistreated with various antibiotics, requiring better diagnostic accuracy to decrease inappropriate antibiotic use and optimize patient care.
There was also a significant rate of discordant diagnosis, where patients who received CDI diagnoses being subsequently revised to C. difficile colonization.1 This is according to a poster presented at Digestive Disease Week 2024.
“[CDI] management is complicated, and inappropriate treatment may exacerbate and prolong illness. Unnecessary treatment of C. difficile colonization or post-infectious IBS may precipitate further recurrences,” wrote authors of the abstract.
Misdiagnosis is common in CDI. In the case of Whitt et al’s abstract, many suspected CDI cases were later revised to C. difficile colonization.
Every year, CDI accounts for 15,000 deaths in the US and approximately $5 billion in US health care costs. | image credit: Yurii Kibalnik / stock.adobe.com
“We define ‘C. difficile colonization’ as the detection of the organism in the absence of CDI symptoms and ‘C. difficile infection’ as the presence of C. difficile toxin (ideally) or a toxigenic strain type and clinical manifestations of CDI,” wrote Crobach et al.2
READ MORE: What Is The Link Between Antidepressants and Hospital-Acquired Clostridium Difficile Infection?
Every year, CDI accounts for 15,000 deaths in the US and approximately $5 billion in US health care costs. These statistics may also be exacerbated by providers’ inability to separate CDI from colonization or non-CDI diarrhea.1
With mistreatment and discordant diagnosis being commonplace in the management of CDI, researchers aimed to address the issue and quantify how common these practices are in a real-world setting.
Researchers used UVA Complicated C. difficile Clinic data from 63 patients and 201 disease episodes to evaluate diagnostic accuracy, guideline adherence, and treatment outcomes.
Diagnostic accuracy was measured by true CDI cases detected compared with colonization or non-CDI diarrhea. They then analyzed the use of antibiotics to treat the infection, measuring the antibiotic risk factors at patients’ initial CDI episode and at its recurrence.
Of the 201 disease episodes, researchers found that 95.5% of initial diagnoses were assessed as CDI. However, upon revised diagnosis, that went down to 79.1% suggesting CDI. And finally, they found that 17.8% resulted in discordant diagnosis; with 75% of discordant diagnosis comprising of C. difficile colonization.
When addressing the use of antibiotics to treat CDI, true CDI cases improved the most (95%) with antibiotic treatment compared with their use to treat colonization or non-CDI diarrhea (68.3%).
However, among the 63 patients experiencing CDI episodes, antibiotic treatment was more commonly associated with risk factors for further CDI episode recurrences.
“Non-CDI antibiotic use was the most common risk factor associated with patients experiencing their first episode of CDI. In comparison, CDI antibiotic use was the most common risk factor for patients undergoing a recurrent episode,” continued the authors.1
Indeed, 83.6% of patients with first-time CDI recently used non-CDI antibiotics, while 93.3% of patients with recurring CDI had recently been prescribed CDI antibiotics. Furthermore, 70% of all episodes managed received a standard dose of antibiotics recommended by the 2017 Infectious Diseases Society of America. For episodes receiving non-standard treatment, 88.3% received a non-standard dose of vancomycin.1
The abstract results show a need to improve both CDI management and diagnosis. Researchers addressed the need for better provider education to successfully execute medical adherence and optimize patient care.
“Misdiagnosis of CDI and potentially inappropriate use of antibiotics are common. Physician education is needed to improve guideline adherence and patient outcomes,” concluded the authors.1 “Exposure to antibiotics, including those against C. difficile, can predispose to CDI. In addition to infection control, diagnostic and antibiotic stewardships are needed to control the spread of CDI.”
Click here for more of our coverage from Digestive Disease Week 2024.
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References
1. Whitt C, Cios K, Behm B, et al. Diagnosis and treatment of clostridioides difficile infection: inconsistent practices and the downstream effects. Presented at: Digestive Disease Week 2024; May 18-21, 2024; Washington, DC.
2. Crobach MJT, Vernon JJ, Loo VG, et al. Understanding Clostridium difficile Colonization. Clin Microbiol Rev. 2018;31(2):e00021-17. Published 2018 Mar 14. doi:10.1128/CMR.00021-17
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