Abstract

GONCALVES, Cristiana V. et al. Retrospective Comparative Study Between Primary-Infection and Relapse of Clostridium difficile Disease. Medicina Interna [online]. 2018, vol.25, n.2, pp.107-112. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/original/268/2/2018.

Introduction:Clostridium difficile infection has worryingly increased in incidence, severity and relapse rates. Methods: An 18-month retrospective analysis was carried out based on the clinical records of patients with confirmed infection hospitalized in Beatriz Ângelo Hospital, Portugal. Subjects were divided into two groups: ‘primary-infection’ and ‘relapse’. The following clinical characteristics were assessed: age, gender, community versus hospital acquired infection, previous antibiotic therapy, proton-pump inhibitors use, severity criteria (namely, > 65 years, leukocytes > 20 000/uL and creatinine > 1.5 above baseline), antibiotics used, duration of antibiotic therapy, hospital length-of- stay and mortality. Results: Overall severity was higher in primary-infections (leukocytes > 20 000/uL 21.3% vs 12.0%, creatinine> 1.5 from baseline 38.3% vs 20.8%), as were patient’s mortality rates (23.4% vs 4.0%). Although vancomycin is recommended – in monotherapy or in association with metronidazole – in severe disease, our study showed that in patients with primary-infection plus 2 or 3 severity criteria, metronidazole alone was the most frequent choice (46.2% if 2 criteria present and 57.1% if 3 criteria present). In recurrent infections vancomycin was the initial choice even in less severe cases (100.0% if no criteria and 68.8% if 1 criteria present). Proton-pump inhibitors use was higher in relapses (84.0% vs 65.2%). Conclusion:This study suggests that primary-infections comprise greater clinical severity and mortality; emphasizes the importance of a severity scoring system to assure appropriate antibiotic regimens and supports the idea that proton-pump inhibitors might be a risk factor.

Keywords : Clostridium Infections; Clostridium difficile; Metronidazole; Proton Pump Inhibitors; Recurrence; Vancomycin.

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