TOPLINE

Atypical presentations of Clostridioides difficile infection (CDI) without initial diarrhea were associated with significantly delayed treatment and more than doubled 90-day mortality compared with typical presentations in hospitalized adults. Furthermore, gastrointestinal dysmotility occurred in nearly one third of patients at diagnosis and persisted radiologically for up to 6 weeks.

METHODOLOGY

• Researchers conducted a retrospective cohort study of hospitalized adults (≥ 18 years) with CDI at a single tertiary health service in Australia between January 2018 and December 2021.
• The cohort had a median age of 70 years and 48% were men.
• A total of 467 CDI episodes were analyzed for clinical and radiologic features of gastrointestinal dysmotility at diagnosis, during admission, and in relation to timing of diarrheal onset.
• Atypical presentations were defined as one or more CDI-associated symptoms persisting for > 24 hours before diarrheal onset (vomiting, acute abdominal distension, abdominal pain, constipation, delirium, fever, or per-rectal bleeding due to CDI).
• The primary outcome was the proportion of atypical vs typical CDI presentations; secondary outcome measures included time to diagnostic testing and directed therapy, 30-day mortality, and 90-day mortality.

TAKEAWAY

• Gastrointestinal dysmotility occurred in 32% of episodes at diagnosis and persisted radiologically for up to 6 weeks; in 49.7% of dysmotility cases, no identifiable contributing factor was present, consistent with CDI itself driving the motility disturbance.
• Any small-bowel involvement was identified in 44 of 270 baseline imaging episodes (16.3%).
• Atypical presentations occurred in 91 of 467 episodes (19.5%) and were associated with significantly delayed treatment compared with typical presentations (median 4 days vs 2 days; P < .001).
• Patients with atypical presentations had increased 90-day all-cause mortality compared with those with typical presentations (24.2% vs 9.6%; hazard ratio, 2.62; P = .001).

IN PRACTICE

"Clinical and radiologic features of acute large and small bowel dysmotility are common in hospitalized adults with CDI and frequently associated with atypical presentations that confer increased mortality," the authors wrote.

"Expanding CDI guidelines to formally recognize atypical presentations, incorporate delirium and small bowel radiologic criteria, and provide guidance on empiric therapy, could meaningfully reduce global mortality from this disease," they added.

SOURCE

The study was led by Emma Bishop, Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria, Australia. It was published online on August 25 in Clinical Infectious Diseases.

LIMITATIONS

The single-center retrospective design may limit generalizability to other healthcare settings. Imaging was not performed consistently across all patients. Direct measurement of bowel motility, such as transit times and muscle contractions, was not possible.

DISCLOSURES

No specific funding was reported for the study. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.