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Observational Study
. 2025 Feb;38(1):48-54.
doi: 10.37201/req/086.2024. Epub 2024 Nov 26.

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

[Article in Spanish]
J M Barbero Allende  1 , I Ureña, L Cañivano, S García, C Paz, A Olmo-Ruiloba, K Jauregi, S Coronado, L López Requejo, L Porcel, V Perea, M Irigoyen, J Cano, A García, E León, N Fernández-Domingo, P Lanchares, B Lino, M Ortolá, A Lizasoain, V Sánchez, C Arévalo-Cañas, J Arévalo-Serrano
Affiliations
Observational Study

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

[Article in Spanish]
J M Barbero Allende et al. Rev Esp Quimioter. 2025 Feb.

Abstract
in English, Spanish

Objective: One of the main problems with Clostridioides 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.

Methods: This is a retrospective study conducted at the Hospital Universitario Príncipe de Asturias on cases of CDI between January 2021 and June 2023. Demographic 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 recurrences (26.3%). Of these 68 recurrences, 63 cases received nonoptimal 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.

Introducción: . Uno de los principales problemas de la infección por Clostridioides difficile (ICD) es su tendencia a la recidiva. El objetivo del estudio es analizar qué factores del manejo clínico de la ICD favorecen ésta.

Material y métodos: Estudio observacional longitudinal retrospectivo realizado en el Hospital Universitario Príncipe de Asturias sobre casos de ICD diagnosticados entre enero/2021 y junio/2023. Se registraron variables demográficas, comorbilidades, factores de riesgo de recidiva y tratamientos empleados para la ICD. Se definió como manejo NO óptimo: la no retirada del tratamiento con inhibidores de la bomba de protones (IBP) si el paciente lo recibía, la no retirada de tratamientos anti-bióticos concomitantes si se encontraba con estos, el uso de metronidazol en monoterapia en cualquier circunstancia o de vancomicina en pauta estándar si existían factores de riesgo de recidiva.

Resultados: Se encontraron 327 casos de ICD en 256 pacientes, 69 de los cuales fallecieron en las 8 semanas posteriores al episodio (26,9%). Entre los 258 episodios restantes, hubo 68 recidivas (26,3%). En 63 casos de estas recidivas el manejo no había sido óptimo (93,2%), frente a 112/190 (58,9%) entre los que no hubo recidiva. En el análisis multivariante ajustado por factores de confusión, los pacientes que recibieron un tratamiento óptimo tuvieron un 89% menos de riesgo de sufrir recidiva frente a aquellos que no lo recibieron (OR 0,11; p < 0,001).

Conclusiones: Disminuir el consumo de IBP y antibióticos y priorizar tratamientos más efectivos frente a la ICD podría mejorar las tasas de recidiva de esta infección.

Keywords: Clostridioides difficile infection; bezlotoxumab; fidaxomicin; recurrence.

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Conflict of interest statement

Los autores declaran no presentar conflicto de intereses

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