Opioid Use Worsens C Difficile Outcomes

Opioid use is strongly associated with increased severity of infection, mortality, and length of stay (LOS) among hospitalized patients with Clostridium difficile infection (CDI), according to a recent study.

Findings from the study were presented on October 16, 2017, at the World Congress of Gastroenterology at the American College of Gastroenterology (ACG) 2017.
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CDI has several risk factors that are known to be associated with worse outcomes. However, opioid use is currently not recognized as a potential risk factor.

For their study, the researchers conducted a retrospective review of 302 medical records of adult inpatients with clinically diagnosed CDI with more than 3 days hospital LOS during a single year. Patients were categorized as “on opioids” if they received more than 10 mg of a morphine-equivalent dose of opioids, or “no opioids” if they were exposed to a lesser dose.

The adjusted associations between opioid use and indicators of CDI severity, mortality, and LOS were estimated via logistic regression and generalized linear regression analyses. The researchers noted that regression covariates included prior antibiotic use, acid suppressive medication use, hospital- vs community-acquired CDI, comorbidities, and other demographics.

Results indicated that 175 (58%) CDI charts had significant opioid use. The researchers observed that patients on opioids had a higher risk for severe or complicated CDI, compared with non-users (54.8% vs 39.3%). Furthermore, more patients on opioids had complicated CDI vs non-users (12.6% vs 5.5%).

There had also been statistically significant differences between opioids and components of CDI severity, white blood cell count elevation, and creatinine rise. According to the researchers, in-hospital mortality had been more common in patients on opioids vs non-users (23.1% vs 11.1%), and average hospital LOS had been longer in patients on opioids vs non-users (25.1 days vs 15.3 days).

“A prior study showed weak associations between opioid use and measures of CDI severity,” the researchers concluded. “This follow-up study demonstrated strong associations between opioids and CDI severity, mortality, and LOS among hospitalized patients with CDI. This study, while limited by its retrospective design, highlights a growing concern that opioid administration for pain control could be harming hospitalized patients with CDI.”

—Christina Vogt

Reference:

John ES, Huss B, Moradi D, et al. A follow-up study about opioids in Clostridium difficile infections: lengthening the road to recovery and hospital stays. Paper presented at: World Congress of Gastroenterology at ACG2017; October 13-18, 2017; Orlando, FL. https://www.eventscribe.com/2017/wcogacg2017/fsPopup.asp?Mode=posterInfo&PosterID=115890.