Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Incidence of Multiply Recurrent CDI in the US
Ann Intern Med; ePub 2017 Jul 4; Ma, et al
Multiply recurrent Clostridium difficile infection (mrCDI) has disproportionately increased in the US relative to CDI, a recent study found. The retrospective cohort study included 38,911,718 commercially insured patients, of whom 45,341 developed CDI. Researchers found:
- From 2001 to 2012, the annual incidence of CDI and mrCDI per 1,000 person-years increased by ∼43% and ~189%, respectively.
- The increase in mrCDI was independent of known risk factors for CDI.
- Patients who developed mrCDI were older and more likely to be female and to have used antibiotics, proton-pump inhibitors, or corticosteroids.
- Diagnosis in a nursing home and chronic kidney disease were also associated with increased mrCDI risk.
Ma GK, Brensinger CM, Wu Q, Lewis JD. Increasing incidence of multiply recurrent Clostridium difficile infection in the United States: A cohort study. [Published online ahead of print July 4, 2017]. Ann Intern Med. doi:10.7326/M16-2733.
This Week's Must Reads
Must Reads in Infectious Diseases
Rapid Point of Care Test for Influenza, J Am Board Fam Med; 2019 Mar; Dale, et al
Invasive GBS Infections in Nonpregnant US Adults, JAMA Intern Med; ePub 2019 Feb 18; Francois Watkins, et al
Prescribed Opioids & Risk of CAP in Patients with HIV, JAMA Intern Med; 2019 Jan 7; Edelman, et al
Influenza Vaccination Safety During Hospitalization, Mayo Clin Proc; ePub 2019 Jan 8; Tartof, et al
Hospitalization Trends for Drug-Use Associated IE, Ann Intern Med; ePub 2018 Dec 4; Schranz, et al
C. diff diarrhea used to be thought to only occur in the hospital and in patients who received broad spectrum antibiotics. Treatment with metronidazole was prescribed and patients responded relatively well. Then, it became apparent that 13%-50% of CDI recurred after initial treatment with antibiotics.1 About 10 years ago, C. diff made its way into the community and was increasingly reported as a community-acquired infection, usually following the use of antibiotics. The current study shows that C. diff infections, as well as recurrent infections with C. diff, have increased substantially over the last 10 years. The treatment for an initial infection with C. diff remains straightforward, as the Infectious Disease Society of America guidelines recommend metronidazole as the drug of choice for initial episodes of mild‐to‐moderate CDI.2 Vancomycin is the drug of choice for an initial episode of severe CDI. Treatment of the first recurrence of CDI is the same as for the initial infection. Treatment for multiply recurrent C. diff is more challenging. Treatment for mrCDI is vancomycin with tapered and/or pulse dose regimen, or the recently studied fecal microbiota transplantation. —Neil Skolnik, MD