Treatment of Clostridium difficile infection in a French university hospital

Abstract

The management of Clostridium difficile infection (CDI) has become very daunting over the past decade because of increased incidence and severity both in hospital and the community. Guidelines recommend metronidazole, vancomycin, or fidaxomicin, depending on clinical presentation. Objective. Our objective was to describe CDI management and assess empirical CDI therapy complying with practice guidelines. Methods. We performed a 2-year prospective cohort study in a university teaching hospital in Lyon, France. Criteria assessing the conformity of CDI patient management were: time elapsed between testing and start of treatment specific to CDI, antibiotics to fight CDI and treatment duration according to infection severity, concomitant therapy, and use of antidiarrheal drugs. Results. Among 118 patients with confirmed CDI, 98 (83%) were specifically treated for CDI. Severe CDI was observed in 63 patients (53.9%). Treatment included metronidazole alone in 72 patients (73.5%), vancomycin alone in 1 patient (1%), and both in 25 patients (25.5%). The percentage of CDI treatment compliance with published guidelines in our hospital at the study period varied between 22% and 93%. A total of 16 patients (13.6%) died within 30 days after diagnosis. Death was related to CDI in nine patients (56.3% of deceased cases). Conclusion. This study identified significant gaps in our knowledge of CDI treatment. Increasing disease severity highlights the need to investigate antibiotic treatment in severely ill CDI patients, as data on this group are currently lacking.

Key Words:

• Antibiotic use
• Clostridium difficile infection
• compliance
• guidelines
• severe

Acknowledgments

The authors thank Mr Ovid Da Silva for editing this manuscript; Professor Nick Daneman at the Sunnybrook Health Sciences Centre, Toronto for revising this work; Sanofi Pasteur, France, the laboratory of microbiology of Groupement Hospitalier Est, and the clinical teams of Groupement Hospitalier Edouard Herriot, HCL, Lyon.

Declaration of interest: Nagham Khanafer received a grant for her PhD studies from Sanofi Pasteur, France. The other authors do not have any conflict of interest to declare. Transparency declarations: No author has a conflict of interest associated with the pulication of this work and all authors meeet standard criteria for authorship. Specifically, Dr Nagham Khanafer contributed to the conception, data acquisition, analysis and interpretation, drafting of manuscript, and final approval; Professor Lucie Blais actively participated in conception, revising and final approval of the manuscript; Dr Frédéric Barbut and Professor Bernard Hirschel partook in the interpretation, revision, and final approval of the manuscript; Professor Philippe Vanhems was involved in the conception, revision, and final approval of the manuscript. All authors have approved the final manuscript we are submitting today.