Study Doesn’t Support Extending CDI Treatment in Patients on Concurrent Antibiotics

Duration of treatment for patients with Clostridioides difficile infection on concurrent antibiotics didn’t affect recurrence rates in a recent study.

The retrospective chart review study, published in the American Journal of Infection Control, included 223 adults who received at least 10 days of therapy for hospital-acquired CDI while receiving concurrent antibiotics at four hospitals in Calgary, Alberta, between October 2017 and 2019.

While current guidelines recommend discontinuation of concurrent antibiotics for other indications, when possible, to decrease risk of CDI recurrence, the study found that 40% of hospital-acquired CDI patients were on concurrent antimicrobial therapy. CDI treatment is routinely extended based on that and other factors.

Investigators analyzed the rates of CDI recurrence at 90 and 180 days among patients receiving a standard duration of therapy (SDT) compared with those receiving an extended duration of therapy (EDT). Participants were in two groups, with 106 receiving the standard duration of therapy for an average of 11 days and 117 in the extended duration of therapy for an average of 24 days.

“In examining our cohort of HA-CDI patients, we did not find a difference in the rate of CDI recurrence when comparing SDT and EDT groups,” the authors, led by Irina Rajakumar, BScPhm, ACPR, BCIDP of Alberta Health Services, wrote. “Other studies on this topic have found mostly similar results when examining the effect of extended duration treatment on CDI recurrence.”

At 90 days, CDI recurrence rates were 22% among the SDT group and 26% among the EDT group (P = 0.40). At 180 days, CDI recurrence rates were 26% among the SDT group and 31% among the EDT group (P = 0.47). Incidence of new onset vancomycin-resistant enterococcus also was not statistically significant at 6% in the SDT group compared with 9% in the EDT group (P = 0.29).

“Overall, we did not find evidence to support the practice of extending CDI therapy for patients on concurrent antibiotics,” the authors concluded. “However, future studies in the form of randomized control trials would be beneficial in assessing the impact of CDI treatment duration on rates of recurrence while balancing the risk of CDI between comparator groups by controlling for duration and type of concurrent antibiotics.”

CDI is common among hospitalized patients on broad-spectrum antibiotics and contributes to prolonged hospital stays and extra cost. In Canada, hospital-acquired CDI patients experience 5.6 extra days in the hospital, costing an additional $18,386. About a third of CDI cases are recurrent.

The overall burden of CDI is estimated to have decreased by 24% between 2011 and 2017, but the disease remains a significant burden and a primary focus of efforts to lower healthcare-associated infections.

Most current guidelines recommend treating primary CDI with oral vancomycin for 10 days. A recent study supports vancomycin as a secondary prophylaxis to prevent recurrent CDI among patients with a history of CDI in the past three months receiving systemic antibiotics.

Other therapies for the prevention or treatment of recurrent CDI include Rebyota, the first FDA-approved fecal microbiota treatment, and VE303, a novel oral microbial therapy under development by Vedanta Biosciences.