N8. Clostridium difficile
Oral Abstract Submission
Background : Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. Several drugs are known to increase CDI risk, although the association between opioids and CDI risk has not been clearly established. Opioid analgesics have gastrointestinal antimotility and immunomodulatory effects, which may predispose patients to infection. The purpose of this study was to determine the association between opioid use and CDI risk.
Methods : This was a retrospective case-control study that utilized inpatient and outpatient data from the national United States Veterans Health Administration (VHA). CDI patients included those age 18 to 89 years with an ICD-9-CM code for CDI (008.45), a positive stool test, and active CDI therapy between Oct 1, 2002 and Sep 30, 2014. A control cohort of VHA patients was created by randomly sampling patients without a CDI ICD-9-CM code during the study period and matched to CDI patients by visit setting and fiscal year. Opioid use was defined as at least one prescription for morphine, hydromorphone, hydrocodone, and/or codeine in the 90 days prior to study inclusion. The chi-square test was used to compare the proportion of patients who received an opioid in the CDI and control groups. Opioid risk factors for CDI were analyzed using a multivariable logistic regression model that included 33 covariates.
Results : A total of 85,451 patients were included in this study (26,149 CDI patients and 59,302 controls). Overall, 50.1% and 30.1% of patients were prescribed an opioid in the CDI and cohort group, respectively. Overall, opioids were associated with significantly increased CDI risk (OR 1.92, 95% CI 1.86-2.00) and was even greater for > 1 opioid (OR 2.40; 95% CI 2.25-2.55). Opioids with the strongest association with CDI risk include morphine (OR 2.04, 95% CI 1.95-2.13), followed by hydromorphone (OR 1.74, 95% CI 1.63-1.87), codeine (OR 1.56, 95% CI 1.44-1.70), and hydrocodone (OR 1.14; 95% CI 1.09-1.19).
Conclusion : In a national cohort of veterans, patients with recent opioid analgesic use had an increased risk of developing CDI compared to a control group. Opioid analgesics with greater immunomodulatory and constipating effects were associated with increased risk compared to other opioids.