Outpatient Parenteral Antimicrobial Therapy Results in Low C. diff Infection Rate

PHILADELPHIA, PA—Patients who received community outpatient parenteral antimicrobial therapy had a low incidence of Clostridium difficile infection, a study reported at IDWeek 2014 has found.

Furthermore, the 5 patients who did develop C. difficile infection had a recent healthcare exposure, and 4 “were on concomitant acid suppressive therapy,” noted Ken Koon Wong, MD, of the Cleveland Clinic Foundation, Cleveland, OH.

“Hospital stay and antimicrobial therapy are the major risk factors for developing C. difficile infection,” Dr. Wong noted. “Community outpatient parenteral antimicrobial therapy allows patients to reside in the community while being treated.” This study evaluated the incidence and clinical outcomes of community onset C. difficile infection in patients treated with community outpatient parenteral antimicrobial therapy.

Dr. Wong and colleagues retrospectively reviewed the charts of all patients 18 years of age or older who had been discharged home with community outpatient parenteral antimicrobial therapy from January 1, 2013–January 1, 2014. If patients developed symptomatic diarrhea with positive stool toxin PCR assay within 4 weeks of initiation of community outpatient parenteral antimicrobial therapy, they were identified as having C. difficile infection. Electronic medical record review was used to identify known C. difficile infection risk factors, severity, treatment, recurrence, readmission, and attributable mortality.

During 2013, a total of 2,401 patients were discharged on community outpatient parenteral antimicrobial therapy, 681 through the Cleveland Clinic Home Care agency.

Five patients (0.73%) developed community onset C. difficile infection, for an estimated incidence rate of 0.26 cases per 1,000 patients days. 

Two of the 5 patients had received piperacillin/tazobactam and amikacin for a median duration of 12 days (IQR 6.5–28). Four of 5 patients completed community outpatient parenteral antimicrobial therapy prior to developing community onset C. difficile infection, with a median duration of 9.5 days (IQR 3–13) prior to infection. Excluding follow-up office visits, all 5 patients had a recent exposure to a healthcare facility. Median duration from exposure to development of community onset C. difficile infection was 8 days (IQR 2–11.5).

Of the 5 patients, 2 had hospital readmissions (neither related to C. difficile infection) and 3 had outpatient procedures. Four of 5 (80%) patients were on concomitant acid suppressive therapy. All patients had mild to moderate C. difficile infection and responded to medical therapy. No history of C. difficile infection recurrence or attributable mortality was observed.  Dr. Wong noted, “Two major risk factors for developing C. difficile infection are antimicrobial therapy and healthcare facility exposure.”