Infection Control and Prevention Unit, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel; Statistical Unit, Lady Davis Carmel Medical Center, Haifa, Israel.
Microbes Infect. 2024 Jul-Aug;26(5-6):105349. doi: 10.1016/j.micinf.2024.105349. Epub 2024 May 6.
Recurrent Clostridioides difficile infection (CDI) poses healthcare challenges and morbidity. Preventing recurrence with prophylactic oral CDI antibiotics lack consensus.
We used data from the largest healthcare provider in Israel to identify all adults aged 18 years or older diagnosed with a first episode of CDI (Index CDI) between February 2018 and December 2022 and subsequently received a non-CDI antibiotic within 2-8 weeks. Patients who received a concurrent prophylactic CDI antibiotic constituted the CDI prophylaxis group. Multivariable Cox proportional hazard regression models were used to examine the association of secondary CDI prophylaxis with CDI recurrence according to the severity of the index CDI (primary objective) and with 4- and 8-week all-cause mortality (secondary objective).
A total of 434 eligible patients were included. Among them, 327 did not receive CDI antibiotic prophylaxis, while 107 did. CDI antibiotic prophylaxis was associated with a significant risk reduction of CDI recurrence with an adjusted HR of 0.51 (95% CI, 0.27-0.97). The magnitude of the association was modified by the severity of the index CDI episode (P for interaction 0.0182). Specifically, the HR for recurrence was 0.163 (95% CI 0.045-0.593) for non-severe CDI, and 1.242 (95% CI 0.524-2.946) for severe CDI. No significant association was found between CDI antibiotic prophylaxis and 4-8 weeks mortality.
Secondary prophylaxis with CDI antibiotics appears to be associated with a reduced risk of recurrence in patients with previous non-severe CDI episode. Further studies are needed to confirm this finding.
复发性艰难梭菌感染（CDI）对医疗保健构成挑战并导致发病率上升。使用预防性口服 CDI 抗生素预防复发尚未达成共识。
我们使用以色列最大的医疗服务提供商的数据，确定了所有在 2018 年 2 月至 2022 年 12 月期间被诊断为首次 CDI（首发 CDI）的 18 岁或以上成年人，并在 2-8 周内随后接受了非 CDI 抗生素治疗。接受同时预防性 CDI 抗生素治疗的患者构成 CDI 预防治疗组。多变量 Cox 比例风险回归模型用于根据首发 CDI 的严重程度（主要目的）以及 4 周和 8 周全因死亡率（次要目的）检查继发 CDI 预防与 CDI 复发之间的关联。
共纳入 434 名符合条件的患者。其中，327 名患者未接受 CDI 抗生素预防治疗，107 名患者接受了预防治疗。调整后的 HR 为 0.51（95%CI，0.27-0.97），表明 CDI 抗生素预防治疗与 CDI 复发风险显著降低相关。首发 CDI 严重程度改变了关联的幅度（交互作用 P 值为 0.0182）。具体来说，非严重 CDI 的复发 HR 为 0.163（95%CI 0.045-0.593），严重 CDI 的复发 HR 为 1.242（95%CI 0.524-2.946）。未发现 CDI 抗生素预防治疗与 4-8 周死亡率之间存在显著关联。
对于既往非严重 CDI 发作的患者，使用 CDI 抗生素进行二级预防似乎与复发风险降低相关。需要进一步的研究来证实这一发现。
