(789) Antibiotics in Recurrent Clostridium difficile Infections in Pre-Procedure Patients

Introduction: Recurrent Clostridium difficile infection (CDI) poses a significant medical challenge due to high relapse rates and limited treatments. Surgical antibiotic use can increase CDI risk, emphasizing the need for pre-surgery prophylaxis. Proper prophylactic antibiotic selection can reduce CDI incidence. Some studies highlight the link between specific antibiotics like ertapenem and increased CDI risk in surgical patients. Others promote antibiotic stewardship programs to lower post-surgery CDI rates. Changing antibiotic prophylaxis, such as using a single metronidazole dose, has proven effective in decreasing CDI rates post colorectal surgeries.

Methods: The study involved a comprehensive retrospective chart review of all cases managed by our institution's C. difficile consultation service, dating back to 2018. This review encompassed patients with a history of recurrent CDI who visited the hospital for both outpatient and inpatient procedures. For our case-control study, the controls were patients with a history of recurrent CDI who did not experience a C. difficile infection recurrence after the procedure. The cases were patients who experienced a recurrence after the procedure. We compared the antibiotic usage and the duration, as well as demographic characteristics such as sex, age, and race, between the cases and controls.

Results: The sample included 363 patients with a history of recurrent CDI, which were divided into 162 controls and 203 cases. All the data was thoroughly studied and analyzed. The chi-square test of homogeneity was used to determine if there were significant differences between the distributions of cases and controls across different categories of sex, race, and age. The results revealed that while sex does not differ significantly between cases and controls, there are significant differences in the distribution of both race and age groups.

Conclusions: The results of the study suggest that the race and age of a patient can be associated with a risk factor that can be linked to the recurrence of Clostridium difficile infection. Consequently, it is crucial to optimize the use of prophylactic antibiotics based on guidelines and individual patient needs to mitigate the risk of recurrent CDI associated with surgical procedures.