Nonelderly Patients Vulnerable 2 Years After C Difficile Infection

Tamar Barlam, MD

The long-term health care burden after Clostridium difficile (C difficile) infection (CDI) is great for elderly patients. But even nonelderly patients are at risk for gastrointestinal symptoms for up to 2 years afterward, according to a new report.

Investigators retrospectively examined the gastrointestinal diagnoses and C difficile infections during hospitalizations in the 24 to 36 months following an initial episode of CDI in order to characterize outcomes in a nonelderly population. Patients admitted to the hospital between 2010-13 were included in the analysis if they were <65 years, had a C difficile infection diagnosis in 2011, had at least 12 months of continuous enrollment, and had follow-up with for 24 to 36 months.

During the follow-up period, the investigators used hospital claims to evaluate gastrointestinal diagnoses. A total of 5632 patients were identified in 2011 and included in the study.

The investigators believed that “C difficile infection would have an impact even in a putative low-risk group (healthier, younger people—less than 65 years of age),” study author Tamar Barlam, MD, Boston University School of Medicine, told MD Magazine®.

On average, the patients were 47 years old and the majority were female. The majority also lived in urban areas and about a third lived in the Southern region of the US.

The risk for gastrointestinal diagnoses for patients who had experienced C difficile infection was about 8 times higher in the 3 months post-infection than for comparable patients without C difficile. This, the investigators said, was statistically significant until about the 24th month.

Between months 6 and 15 in the follow-up period, there appeared to be a downward trend of C difficile diagnoses, which plateaued around 10.7% between months 15 and 27. The average number of gastrointestinal diagnoses per admission was 4.19 codes at the time of initial C difficile infection episode and rose to 5.5, 7.99, and 7.42 codes at 1, 2, and 3 years of follow-up, respectively.

Patients in the Northeast and West had decreased risk of gastrointestinal diagnoses compared to the South, the study authors added. Gender did not influence risk of gastrointestinal diagnoses.

“The importance of the gut microbiome is better understood each year and C difficile and its treatment disrupts that microbiome,” Barlam said. “We did find a significant impact in that cohort and were surprised how long that impact seemed to last—up to 2 years&mdash;before the cohort returned to a pre-C difficile baseline. I think data like this will continue to move us towards treatments that restore the microbiome as well as treat the C difficile infection, across risk groups.”

The study authors admitted that the total healthcare impact may be underestimated within C difficile infection studies because the nonelderly patients with low rates of comorbidities is not well examined. Plus, they noted that a study of adults aged 65 and over found that patients with C difficile infection had nearly twice the mortality and healthcare costs compared with healthy matched samples without C difficile infection.

Thus, “little is known about the healthcare burden in nonelderly patients,” they wrote. “Our study demonstrates that long-term impacts are important, and C difficile infection poses a greater burden to public health than previously demonstrated, even in this relatively healthy nonelderly cohort.”

The paper, “Retrospective analysis of long-term gastrointestinal symptoms after Clostridium difficile infection in a nonelderly cohort,” was published in PLOS ONE.