Does Extending Clostridium Difficile Treatment In Patients Who Are Receiving Concomitant Antibiotics Reduce The Rate Of Relapse

Purpose: Exposure to concomitant antibiotics during treatment for Clostridium difficile infection (CDI) is a major risk factor for relapse. This study compared the CDI relapse rates among patients who underwent CDI treatment while receiving concomitant antibiotics. Methods: This retrospective chart review evaluated consecutive adult patients with CDI who were receiving concomitant antibiotics at two acute care sites (Hamilton, Ontario) during 2011–2013. We compared the CDI relapse and mortality rates for regular CDI treatment (10–14 days) and extended CDI treatment (u003e14 days), and adjusted the analyses for several covariates. Results: We identified 457 patients with CDI, and 228 (50%) patients were considered eligible. A total of 101 (44.2%) patients were receiving regular CDI treatment and 127 (55.7%) patients were receiving extended CDI treatment. The relapse rates were similar for the regular and extended treatment groups in the univariate (17% and 23%, respectively; odds ratio [OR]: 1.4, 95% confidence interval [CI]: 0.7–2.7, p = 0.286) and multivariate analyses (OR: 0.7, 95% CI: 0.3–1.7, p = 0.425). A composite outcome (in-hospital mortality and/or CDI relapse) was higher for extended treatment (35% vs. 23%; OR: 1.9, 95% CI: 1.0–3.4, p = 0.039), although this difference was not significant in the multivariate analysis (OR: 1.2, 95% CI: 0.6–2.5, p = 0.648). Conclusions: We found no evidence to support extended CDI treatment among patients who are receiving concomitant antibiotics. However, further studies are needed to identify better methods for reducing the risk of relapse in this population.