Evaluation of the management of Clostridioides difficile infection as a risk factor for recurrence. A retrospective observational study

Abstract

Introduction. One of the main problems with Clostridioi-des difficile infection (CDI) is its tendency to recur. The objective of the study is to analyze which factors in the clinical management of CDI favor recurrence. Material and methods. This is a retrospective study conducted at the Hospital Universitario Príncipe de Asturias on cases of CDI between January 2021 and June 2023. Demogra-phic variables, comorbidities, risk factors for recurrence, and treatments used for CDI were recorded. Non-optimal clinical management was defined as: not discontinuing treatment with proton pump inhibitors (PPIs) if the patient was on them, not discontinuing concomitant antibiotic treatments if the patient was on these, the use of metronidazole monotherapy in any case, or the use of standard-dose vancomycin if there were risk factors for recurrence. Results. A total of 327 cases were found in 256 patients. 69 patients died within 8 weeks after the episode (26.9%). Among the remaining 258 episodes, there were 68 recurren-ces (26.3%). Of these 68 recurrences, 63 cases received non-optimal treatment (93.2%), compared to 112/190 (58.9%) among those who did not recur. In the multivariate analysis adjusted for confounding factors, patients who received optimal treatment had an 89% lower risk of recurrence compared to those who did not receive it (OR 0.1; p < 0.001). Conclusions. Reducing the use of PPIs and antibiotics and prioritizing more effective treatments against CDI could improve the recurrence rates of this infection.