Research has shed new light on the heightened risk of Clostridioides difficile infection (CDI) amongst hospitalized patients consuming certain antidepressants such as mirtazapine, nortriptyline, and trazodone. The data stems from a comprehensive retrospective cohort study, adding significant value to insights highlighted in scattered scholarly literature thus far. An elevated understanding of these risk factors can greatly influence health systems’ effective response to CDI, a pervasive concern in the US with an estimated half a million instances annually. Particularly, two-thirds of these cases surface in enclosed healthcare settings including hospitals and long-term care facilities. Risk factors frequently associated with CDI are age, antibiotics and immunosuppressive medications usage, and proton pump inhibitors.
The study in discussion aimed to quantify the risk of acquiring CDI in a hospital setting for patients consuming antidepressant medications. The research team assembled electronic health records of over 55 million hospitalized patients above 18 years from Explorys. Across this patient pool, a comparative study was undertaken between the 48,720 patients who developed CDI and the disproportionately larger group that did not.
Incidence of antidepressant usage amongst the patient pool was found to be mainly associated with sertraline, citalopram, escitalopram, and fluoxetine, while, clindamycin, beta-lactam, proton pump inhibitors, trazodone, nortriptyline, and mirtazapine usage were predominantly observed amongst patients diagnosed with CDI. A set of underlying conditions such as being female, Caucasian, type 2 diabetes, inflammatory bowel syndrome, irritable bowel syndrome, alcohol usage, and smoking were also observed as prevalent amongst the CDI patient group.
Carrying out multivariate analysis to account for several influencing factors, it was deduced that patients’ risk of CDI remained elevated for those using mirtazapine, nortriptyline, trazodone, clindamycin, beta-lactam antibiotics, and proton pump inhibitors. Noteworthy was the observation that CDI prevalence rose with age across both patient groups on and off antidepressant medication. Further statistical analysis highlighted augmented risk of hospital-acquired CDI specifically amongst patients with inflammatory bowel syndrome and those consuming certain medications.
Upon multivariate regression analysis, the influence of potential risk multipliers like antibiotic medications, proton pump inhibitors, a diagnosis of inflammatory bowel disease, and antidepressant medications was evaluated. This found that CDI risk ceased to be high amongst patients consuming fluoxetine, but maintained its elevation amongst patients with inflammatory bowel disease and those using the aforementioned medications.