Clostridioides difficile infections: Epidemiology, correlations and treatment in a Lebanese cohort with use of ATLAS scoring

  • Jacques Choucair Department of Infectious Diseases, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  • Rami Waked Department of Infectious Diseases, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  • Elie Haddad Department of Infectious Diseases, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  • Marie Chedid Department of Infectious Diseases, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  • Nabil Chehata Department of Infectious Diseases, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  • Gebrael Saliba Department of Infectious Diseases, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
  • Houssam Dahboul Department of Gastrointestinal and Digestive Surgery, Hôtel Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
Keywords: ATLAS score;, Pseudomembranous Colitis;, Middle East;, Outcome;, Treatment, Clostridioides difficile

Abstract

Introduction: The objectives of the present study were to investigate epidemiology, correlations, severity, and therapeutic response of Clostridioides difficile infections in a Lebanese tertiary care hospital.

Methodology: In this retrospective cohort study, patients having at least one positive Clostridioides difficile test (antigen glutamate dehydrogenase/GDH with toxins, or PCR) were studied.

Results: Among 58 patients, 20 (34.5%) and 53 (91.4%) had positive antigen GDH and toxins, respectively. PCR was performed in 25 (43.1%) patients without any positive ribotype 027. Fifteen (25.9%) patients were immunocompromised, 35 (60.3%) patients received antibiotics prior to the infection and 34 (58.6%) on proton pump inhibitors. Fifty-four (93%) patients had a resolution of their symptoms after a mean period of 4.2 days of treatment. Twenty-two (38%) participants were treated with oral vancomycin, 11 (19%) with intravenous metronidazole and 23 (39.6%) with both antibiotics. Resolution of symptoms was significantly more rapid with monotherapy (p = 0.007) with no significant difference between vancomycin and metronidazole (p = 0.413). A positive correlation was found between ATLAS score and delay to symptoms resolution (r = 0.553; p < 0.001; N = 54), as well as between ATLAS score and prevalence of complications (p = 0.003).

Conclusions: History of treatment with antibiotics, proton pump inhibitors, and hospital admission during the previous year were prevalent among our patient cohort. Rates of symptomatic resolution were similar with monotherapy and dual therapy.

Published
2020-12-31
How to Cite
1.
Choucair J, Waked R, Haddad E, Chedid M, Chehata N, Saliba G, Dahboul H (2020) Clostridioides difficile infections: Epidemiology, correlations and treatment in a Lebanese cohort with use of ATLAS scoring. J Infect Dev Ctries 14:1461-1465. doi: 10.3855/jidc.13189
Section
Brief Original Articles