Cassidy Treanor, PharmD
PGY2 Critical Care Pharmacy Resident
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Dayna McManus, PharmD, BCPS-AQ ID
Infectious Disease Pharmacist
Yale New Haven Hospital, United States
Disclosure information not submitted.
Sunish Shah, PharmD
Infectious Disease Pharmacist
Lawrence & Memorial Hospital, United States
Disclosure information not submitted.
Jeffrey Topal, MD
Infectious Disease Physician
Yale New Haven Hospital, United States
Disclosure information not submitted.
Title: Optimizing the Identification of Patients at Risk for Recurrent Clostridioides difficile Infections
Introduction: Clostridioides difficile infections (CDI) are highly prevalent nosocomial infections with <35% of patients at risk for recurrence and worse outcomes. Bezlotoxumab is a monoclonal antibody approved to prevent recurrent CDI and indicated for patients at high risk or with >2 episodes of prior CDI. Our study evaluated bezlotoxumab administration to optimize identification of high risk patients.
Methods: This retrospective study, conducted across five hospitals, identified inpatients who tested positive for CDI between August 2, 2019 and March 31, 2020. Patients met the inclusion criteria if they were aged >18 years and diagnosed with >2 episodes of CDI. Missed opportunities for bezlotoxumab administration were ascertained by identifying patients who experienced a recurrence with >1 high-risk factor (age >65 years, immunocompromised, non-CDI antibiotic use, proton pump inhibitor (PPI) use, NAP1 strain, and/or diagnosis of a severe CDI). Patients who received bezlotoxumab were also characterized based on the risk factors listed above.
Results: 3746 patients were tested for CDI and 31 were found to have >2 episodes of CDI without receipt of bezlotoxumab between episodes. The median age was 71 years and 45.2% were male. Twenty-six patients (83.9%) experienced a recurrence requiring hospital readmission while 5 (16.1%) experienced >2 CDI episodes within the same admission. In regards to the most common risk factors identified, 20 (64.5%) patients were aged >65 years, 20 (64.5%) had a severe primary infection, 19 (61.3%) used non-CDI antibiotics during/after the primary CDI, 12 (38.7%) chronically used PPI and 6 (19.4%) were immunocompromised. Outpatient administration of bezlotoxumab could have been utilized for 24 patients (77.4%). There were 16 patients who received bezlotoxumab during this time period (median age 65 years and 43.8% male). Of these patients, 10 (62.5%) had an immunocompromising condition and 12 (75%) had a severe infection directly preceding bezlotoxumab administration.
Conclusion: While immunocompromised patients or those who have experienced >2 episodes of CDI are consistently captured, other risk factors are less prominently considered. Based on this, a patient list within the hospital system's electronic record was created to identify patients who are candidates for bezlotoxumab therapy.