Research: Multiple C. difficile Infections More Common than First-Time Occurrences

AUGUST 08, 2017
Rachel Lutz
Rates of multiple recurrent Clostridium difficile (C. difficile) infections are disproportionately increased compared to first-time C. difficile infections, according to a new report.

Researchers from the Perelman School of Medicine at the University of Pennsylvania reviewed nearly 40 million commercially insured patients’ medical records in order to determine how quickly and in what proportions multiple recurrent C. difficile infection rates are growing ahead of C. difficile. They also wanted to examine if there were any specific risk factors for multiple recurrent infections. The investigators found the patients through the OptumInsight Clinformatics Database during a period between January 2001 and December 2012.

The researchers also believed that their study would further the understanding of C. difficile infection epidemiology, which could in turn allow for earlier diagnoses in high risk patients.

Throughout the monitoring period, about 45,000 patients had at least one C. difficile episode, and, of those patients, 1,669 experience a multiple recurring infection, according to the study.

While the annual incidence of C. difficile infection increased by 42.7% over the study period, the annual incidence of multiple recurrent C. difficile infections increased by 188.8% in the same period.

“The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” study senior author James D. Lewis (pictured), MD, said. “While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.”

Some of the characteristics of patients who developed multiple recurrent infection compared to those who didn’t included older age, female gender, and use of antibiotics and corticosteroids. The researchers also pointed out that chronic kidney disease also seemed to be a risk factor for multiple recurrent infection, but said that inflammatory bowel disease and diabetes mellitus were not risk factors.

Location also played a role in whether or not patients developed multiple recurrent C. difficile infections. Diagnosis in a home was linked to development of multiple recurrent cases, according to the study. Patients in the Northeast and the Midwest also had higher risks for this, but when the investigators stratified the data by states, they learned that Floridians and Texans had decreased risk for multiple recurrent C. difficile infection.

 “An additional driver of this rise in incidence could be the recent emergence of new strains of C. difficile, such as NAP1, which has been shown to be a risk factor for recurrent C. difficile infection,” Dr. Lewis said.

The researchers concluded by adding that they hope their findings will contribute to greater use of fecal microbiota transplant in the near future. While they said fecal microbiota transplant appears safe and effective in the short term, long term studies are also needed. 

The paper, “Increasing Incidence of Multiply Recurrent Clostridium difficile Infection in the United States,” was published online in Annals of Internal Medicine.

A press release regarding the study was made available. 

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