OBJECTIVES : Clostridium difficile infection (CDI) results or occurs in over 200,000 hospitalizations in the United States annually. Treatment with antibiotics is often successful but 20-30% of patients experience a recurrence. This analysis of real-world hospital data aimed to characterize the treatment regimens for patients experiencing recurrent CDI (rCDI), including both hospital-acquired and community-acquired recurrence, and compare these regimens to current guidelines.

METHODS : Hospitalizations occurring between 10/2017-12/2018 and reporting rCDI (ICD-10-CM diagnosis code A04.71) were identified in the Premier Healthcare Database. Billing records were reviewed for antibiotics commonly used for rCDI – vancomycin, metronidazole, fidaxomicin and rifaximin. Patient demographics, antibiotic treatments (mono/combination therapy) and length of stay (LOS) were characterized.

RESULTS : 12,007 hospitalizations reporting rCDI across 9,824 patients were identified. On average, patients were 66.1 years old, more likely to be female (62%) and receiving Medicare coverage (71%). Vancomycin was used in 94% of hospitalizations (41% and 53% as mono and combination therapy, respectively) while fidaxomicin was reported in 14% of cases (2% and 12% as mono and combination therapy, respectively). Combination therapy, reported in 54% of total cases, was more common than monotherapy. Use of vancomycin and metronidazole was the most common combination therapy (39% of hospitalizations); all other combinations accounted for less than 15% of all hospitalizations. Patients receiving monotherapy had a shorter LOS than those receiving combination therapy (7.1 versus 10.2 days, respectively, p < 0.001).

CONCLUSIONS : The real-world treatment of inpatients experiencing rCDI aligned only moderately with published guidelines, with higher use of metronidazole and lower use of fidaxomicin than might be expected per these recommendations. While current approaches to treatment rely heavily on the effectiveness of vancomycin, the rate of rCDI is increasing, suggesting the need for a more effective alternative and stronger evidence to define the optimal treatment regimen.