958. A Comparison of Clostridium difficile Recurrence Rates with Different Treatment Methods
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Background: Recurrent Clostridium difficile infection (CDI) occurs in up to 25% of patients. Guidelines recommend discontinuing offending antibiotics at the time of CDI diagnosis to reduce the risk of recurrence. When continuation of antibiotic therapy is necessary, some clinicians continue CDI treatment concurrently and prolong the duration of CDI treatment by at least 3 days from the antibiotic stop date. No published studies have evaluated the efficacy of prolonging CDI treatment in such a manner, and the effects on recurrence rates are unknown. The purpose of this study was to evaluate the effects on CDI recurrence rates of prolonged versus non-prolonged CDI treatment when antibiotics are continued.

Methods: This was a retrospective, electronic chart review of patients diagnosed with a CDI.  Subjects were classified into 2 treatment groups – prolonged CDI treatment (defined as 10-14 days of CDI treatment plus an additional ≥ 3 days beyond antibiotic discontinuation), and non-prolonged treatment (defined as at least 10-14 days of CDI treatment ending the day antibiotics are discontinued or ending prior to antibiotics).The primary endpoint was the difference in CDI recurrence rates between treatment groups. Recurrence rates in subgroup analyses, CDI severity, and length of hospitalization were also compared.

Results: The investigators randomly selected 258 charts for review.  Forty patients met inclusion criteria; 20 in each treatment group. Recurrence occurred in 5 (25%) patients receiving prolonged treatment and 3 (15%) patients receiving non-prolonged treatment (p=0.695). The majority of recurrent CDI cases were classified as severe. Of the patients who experienced recurrence, 60% of patients in the prolonged group and 100% in the non-prolonged group received metronidazole for CDI treatment (p=0.464). Discharge location, class of antibiotics at diagnosis and 60 days after treatment completion, and length of hospital stay did not significantly affect recurrence rates between treatment methods (p>0.05).

Conclusion: Prolonging the CDI treatment course did not influence the risk of recurrence in our study. Larger, randomized, prospective trials are needed to investigate this association further.

Rohini Dave, PharmD, Sima Madhiwala, PharmD, BCPS, Patrick Waters, PharmD, AAHIVP and Lisa Young, Pharm.D., BCPS AQ-ID, Pharmacy (119), Jesse Brown Veterans Affairs Medical Center, Chicago, IL

Disclosures:

R. Dave, None

S. Madhiwala, None

P. Waters, None

L. Young, None

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