Prophylactic Probiotics, Nasogastric Feeding Tubes Linked to Recurrent C Difficile Infections

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Recurrent infections occurred in 23.9% of the 134-patient study.

New research has identified a pair of independent risk factors for recurrent clostridium difficile infections (CDI) in prophylactic probiotics and nasogastric feeding tube use.

A team, led by Yuki Yokoyama, Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, identified the risk factors for recurrent CDI following initial treatment.

Recurence Rates

Recurrence is common for patients with C difficile infections, occurring in about 25% of patients following initial treatment.

The majority of patients with initial cases of CDI are managed with metronidazole and/or vancomycin while discontinuing antibiotics when possible. The average period for recurrence following C difficile treatment is 12.6 days, while the median hospital stay is close to double because of CDI recurrence.

“Identifying risk factors for the first recurrence can be thought to reduce the frequency of subsequent recurrences,” the authors wrote.

Risk Factors

There are some known risk factors for recurrent C difficile infections, including advanced age of 65 years or older, a history of antimicrobial use following CDI diagnosis, the presence of serious underlying diseases, including renal failure, and the use of proton-pump inhibitors.

In the retrospective survey of patient backgrounds and treatment-related factors, the investigators analyzed risk factors of 134 patients using single and multiple logistic regression analyses. The mean age of the patient population was 78 years and the majority of participants were male.

All of the CDI episodes studied occurred in patients aged at least 20 years at the time of initial CDI between February 1, 2015 and February 28, 2019. The investigators also collected demographic data on each participant, including age, sex, height, and weight.

Recurrent CDI was identified in 23.9% of the 134 patients included in the study.


For treatment, the majority of patients were treated with metronidazole, while 43 patients were treated with vancomycin. A total of 20 patients treated with metronidazole had rCDI, while 9 of the patients treated with vancomycin had a recurrence of disease.

The also identified medical statistics, including blood pressure, body temperature, medical history, serum creatinine, estimated glomerular filtration rate, Bristol Scale, serum albumin, leukocyte count, platelet count, asparatate aminotransferase, alanine aminotransferase, and alkaline phosphatase.

The team identified prophylactic probiotic use and nasogastric tube feeding were independent risk factors for the initial CDI recurrence.

The results show 43.8% (n = 14) of patients treated with probiotics and 37.5% (n = 12) of patients on nasogastric tube feeding had recurrent C difficile infections.

The recurrence rate of CDI overall is approximately 30%, but in the prophylactic probiotic group, the recurrence rate was 46.7%.

There was also no significant differences observed in the severity of disease.

“Prophylactic probiotic use and nasogastric tube placement may be risk factors for the initial recurrence of CDI,” the authors wrote. “It is noteworthy that CDI that occurs during the use of prophylactic probiotics may be prone to recurrence.”

The study, “Risk factors of first recurrence of Clostridioides difficile infection,” was published online in Anaerobe.